ICDS Programme and Services

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 PART 1
ICDS Programme and Services
Page

1.1 ICDS Programme & Objectives 5

1.2 Administrative & Organisational Set up 8

1.3 ICDS Coverage and Reach 9

1.4 ICDS Beneficiaries and Services 11

1.5 The Anganwadi Centre 12

1.6 ICDS Team, their Role & Job Responsibilities 13

1.7 How to Start and Organize an Anganwadi Centre 20

1.8 Training of ICDS Functionaries & Trainers 24

1.9 Kishori Shakti Yojana 26

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 Special Features of ICDS Programme
4

ICDS
1.1 ICDS Programme & Objectives

ICDS Programme

ICDS is the country’s most comprehensive & multi-dimensional programme. It is a centrally
sponsored scheme of the Ministry of Women and Child Development.

ICDS Programme was launched on 2 October, 1975 – the 106th birth anniversary of
Mahatma Gandhi–the Father of the Nation.

ICDS is the most unique programme for early childhood care and development
encompassing integrated services for development of children below six years, expectant
and nursing mothers and adolescent girls living in the most backward, rural, urban and
tribal areas.

ICDS has child centered approach based on the rationale that child care, cognitive and
psycho - social development, and the child’s health and nutritional wellbeing mutually
reinforce each other.

ICDS is a community based programme. For effective implementation of the programme,

members of the community i.e. members of panchayati raj; mahila mandal & youth
club; religious and local leaders; voluntary organisations and primary school bodies
etc. should be actively involved.

ICDS is the symbol of India’s commitment to her children

Objectives

Lay foundation for the proper psychological, physical and social development of the child.

Improve nutritional & health status of children below six years.

Reduce incidence of mortality, morbidity, malnutrition and school dropouts.

Achieve effective coordination of policy and implementation amongst various departments.

Enhance the capabilities of the mother to look after the normal health and nutritional
needs of child through proper nutrition & health education.

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 Intergenerational Cycle of Malnutrition
6

Pre-Birth Physical Stress

Elimination and Depletion

▲
▲

Early
Pregnancy

ICDS intervenes across the life cycle as early as possible to fulfill the needs and rights of the girl child

ICDS through its package of services creates an environment to reduce gender discrimination at all stages
 ICDS is a major programme channel for addressing child rights related
to survival, protection, participation and development

Right to Survival Right to Protection

Rights for survival include rights related to
life, health, nutrition, water, sanitation,
environment, adequate standard of
living, right to a name from birth, right to
acquire nationality, right to know and be
cared by his or her parents.
Rights for protection include rights related to
protection of children from all forms of
discrimination, exploitation, abuse,
inhuman or degrading treatment and
neglect, disability, right to special
protection in situations of emergency and
armed conflicts.

Right to Participation Right to Development

Rights for participation include rights
related to respect for the views of the child,
right to freedom of expression, thoughts,
conscience and religion; freedom of
association and peaceful harmony; access
to appropriate information and awareness.
Rights for development include rights
related to education, support for early
childhood development and care, social
security and right to leisure, recreation and
cultural activities.

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1.2 Administrative & Organisational Set up

ICDS has well planned administrative and organizational set up.

The Administrative Unit for the location of an ICDS Project is a Community Development
Block in the rural areas, a Tribal Development Block in the tribal areas and a group of
slums in urban areas.

In the selection of the location of a Project, consideration is given to the areas inhabited
predominantly by Scheduled Castes or Tribes especially Backward Tribes or nutritionally
dependence areas or areas poor in reach of social services.

Ministry of Women and Child Development

Govt. of India-

STATE

Department of Social Welfare/ Rural Dev. / Community

Dev./Tribal Welfare/ Women & Child Development

DISTRICT

District Welfare Office / District ICDS Cell

BLOCK

Block Dev. Child Dev. Medical

Officer Project Officer Officer

SECTOR

Block Health Asst.

Supervisor
Mukhya Sevika ( Female )

VILLAGE
Auxiliary
Nurse Midwife

Anganwadi Traditional
Worker Birth Attendant

Health Guide

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1.3 ICDS Coverage and Reach
Population Coverage in an ICDS Project

Area Population Population No. of

Covered / Project Covered / AWC AWC / Project

Rural 1,00,000 1000 100

Urban 1,00,000 1000 100

Tribal 35,000 700 50

In hilly and desert areas an Anganwadi may be set up in every small village or hamlet
having a population of 300 or more. Very small villages/hamlets (with a population less
than 300) can be covered by the adjoining Anganwadis or mini AWC can be set up.

Approximate Population Coverage

in an ICDS Project as per the Services

Target Services Rural / Urban Project Rural / Urban Project

(Population 100,000: (Population 35,000:
Villages 100) Villages 550)
Total Target Percent Total Target Percent
Popula Popula Coverage Popula Popula Coverage
-tion -tion -tion -tion
1 Children
Supplementary 6,800 40 4,462 75
below Nutrition
6 yrs.
Immunisation 17,000 17,000 100 5,950 5,950 100

Health Check-up 17,000 100 5,950 100

Non-formal 8,000 4,000 50 2,800 2,100 75
Preschool
Education

2 Expectant
Supplementary 4,000 1,600 40 1,400 1,050 75

and Nutrition
Nursing
Health Check-up 4,000 4,000 100 1,400 1,400 100
Mothers
Immunisation 2,400 2,400 100 910 910 100
(Tetanus)

3 Mothers Nutrition & 20,000 20,000 100 7,000 5,250 75

(15-45) Health
yrs. Education

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 ICDS Beneficiaries and Services
Beneficiary
Children Less than 3 Children between 3- Expectant and Other Women Adolescent Girls
years 6 Years Nursing Mothers 15-45 Years between 11-18 Years

Services
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i) Supplementary Nutrition i) Health Check-up

ii) Growth Monitoring ii) Tetanus Toxoid Immunization to
pregnant women
iii) Immunization
iii) Supplementary Nutrition
iv) Health Check-up
iv) Nutrition & Health Education
v) Referral Services

i) Non-formal Preschool i) Nutrition & Health Education

Education
ii) IFA Supplementation &
ii) Supplementary Nutrition
de-worming intervention
iii) Growth Monitoring
iv) Immunization iii) Non-formal education
v) Health Check-up iv) Home-based skill training
vi) Referral Services and vocational training
v) Supplementary nutrition
1.4 ICDS Beneficiaries and Services

ICDS Beneficiaries
 Children below six years

 Expectant and Nursing Mothers

 Adolescent girls

 Women in the age group 15-45 years

Services under ICDS

– ICDS provides a package of integrated services in a comprehensive and cost effective
manner to meet the multi - dimensional and interrelated needs of children.

– ICDS beneficiaries receive health, nutrition and early childhood care and education
related services. In addition, there is coverage of other important supportive services
like safe drinking water, environmental sanitation, women’s development and
education programmes.

– All services in ICDS are expected to converge at the same time on the same set of
beneficiaries i.e. group of children and their family to create an appreciable impact.

Integrated Package of Services under ICDS

Nutrition Supportive Services and

Convergence

Supplementary Nutrition

Supportive Services, such as Safe Drinking

Growth Monitoring
Water, Environmental Sanitation,Women’s

Nutrition and Health Education Empowerment Programmes and Adult Literacy

Health Early Childhood Care

& Preschool Education

Health Check up

Immunization
Early Care and Stimulation of Children Under
Three Years

Identification and Treatment of Common
Childhood Illnesses and Minor Ailments
Preschool Education to Children in the 3-6
Years Age Group

Referral Services

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1.5 The Anganwadi Centre

An Anganwadi Centre - a courtyard play centre - located within the village or a slum is the
focal point for delivery of all the services under ICDS programme in an integrated manner
to children and women.

An Anganwadi is a centre for convergence of services for children and women.

An Anganwadi is a meeting ground, where women / mother’s groups can come together/
with other frontline workers to share views and promote action for development of
children and women.

An Anganwadi is run by an Anganwadi Worker who is supported by a Helper in service

delivery.

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1.6 ICDS Team, their Role & Job Responsibilities

A CDPO is an overall incharge of an ICDS
Project and is responsible for planning and
implementation of the Project.

A CDPO is supported by a team of 4-5
Supervisors who guide and supervise
AWWs.

In large ICDS Projects, where there are
more than 150 AWCs in a Project, an
Assistant Child Development Project
Officer is also a part of the team.

A Supervisor has the responsibility of
supervising 20, 25 and 17 Anganwadi
Workers in rural, urban and tribal projects
respectively.

A Supervisor guides an AWW in planning
and organising delivery of ICDS services
at AWC and also gives on the spot
guidance and training as and when
required.

An Anganwadi Worker is a community-
based frontline voluntary worker, selected
from within the local community. The
selection is made by a committee at the
Project level.

An AWW is mainly responsible for
effective delivery of ICDS Services to
children and women in the community.

An AWW is an honorary worker who gets
a monthly honorarium.

At each AWC, a Helper is appointed to
assist an AWW.

Helper is an honorary worker and is paid
monthly honoraium.

Health Services in ICDS are given by a team

of Health Functionaries comprising Medical
Officer, Lady Health Officer, ANM and
Female Health Worker from Primary Health
Centre and Sub-Centre in the Project. At the
community level ASHA will be the first port
of call for any health related demands of
deprived sections of the population,
especially women and children.

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 Role knowledge & Skills of an AWW
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1.6.1 Role & Job Responsibilities of an AWW

An AWW’s multifarious role requires managerial, education, communication

and Counselling Skills. The various job responsibilities of an AWW are:

A. Planning for Implementation of 10. Depot holder of medicine kit

ICDS Programme contraceptives of ASHA and under
1. Village Mapping ICDS
2. Rapport Building with Community 11. Counseling Woman on Birth
Preparedness
3. Conducting Community Survey and 12. Assist CDPOs/Supervisors in
Enlisting Beneficiaries implementation of KSY and NPAG
– Children 0-6 years
– Children ‘At Risk’
– Expectant and Nursing Mothers
C. Information, Education and
– Adolescent Girls
Communication
4. Birth and Death Registration
1. Communicating with counselling
Parents, Families and Communities etc.
2. Organising Awareness Campaigns,
B. Service Delivery Street Plays, etc.
1. Preparation and Distribution of 3. Prepare Communication and
Supplementary Nutrition Educational Material
– Children 6 months to 6 yrs.
– Expectant and Nursing Mothers
– Children and Mothers ‘At Risk’
D. Community Contact
2. Growth Monitoring
Promote Breast feeding and councsel 1. Mobilise Community & Elicit
mothers on IYCF Community Participation
3. Assisting Health Staff in Immunization 2. Maintain Liaison with Panchayat,
and Health Check-up of Children and Primary Schools, Mahila Mandals and
Mothers Health Functionaries etc.
4. Referral Services
5. Detection of Disability among Children
6. Providing Treatment for Minor Ailments
and first aid. E. Management and Organisation
7. Management of Neenatal and Childhood 1. Management of Anganwadi Centre
Illnesses
8. Health and Nutrition Education to 2. Maintenance of Records, Registers and
Adolescent Girls, Women and Visitor’s Books
Community 3. Preparation of monthly progress
9. Organising Non-formal Preschool Reports
Education Activities
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 Role knowledge & Skills of a Helper
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1.6.2 Role & Job Responsibilities of a Helper

In an Anganwadi, a Helper assists an AWW for the following activities:

General Duties
1. Assisting Anganwadi Worker in
conducting all the activities of the
Anganwadi Centre, such as:
a. Counselling mothers and other
caregivers of beneficiary children.
b. Pre-school education activities.
c. Health check-up, weighing of
children, immunization of children /
mothers.
d. Mothers / community meeting.
e. Maintenance of discipline among
children.

Specific Duties
(i) Cleaning premises of Anganwadi
Centre and surrounding area.
(ii) Fetching drinking water for daily use.
(iii) Cooking and serving supplementary
nutrition for beneficiaries.
(iv) Inspection of cleanliness of children
and assisting them in grooming
themselves.
(v) Preparation of preschool teaching aids
under the guidance of an Anganwadi
Worker.
(vi) Collection and storage of items received for supplementary nutrition.
(vii) Collecting and dropping small children.
(viii) Contacting beneficiaries, parents and others in the community to attend meetings or
for conveying messages.
(ix) Opening and closing of an Anganwadi Centre under supervision of an Anganwadi
Worker.
(x) Performing all the duties of an Anganwadi Worker when she is sick, absent or away
from duty or on leave.

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1.6.3 Convergence of Services Among ANM, AWW and
ASHA at Village Level
S. No. ANM AWW ASHA

1. To be invited to the meetings of To be invited to the meetings To be invited to the meetings

the Village Health & Sanitation of the Village Health & of the Village Health &
Committee Sanitation Committee Sanitation Committee

2. To assist in preparation of Village To assist in preparation of Vil- To assist in preparation of Vil-

Health Plan lage Health Plan lage Health Plan

3. Organize Village Health Day at
AWC (Immuization, Antenatal
Check ups (ANC), Postnatal Check
ups (PNC), Health Check ups etc.)
Assist in organizing Village
Health Day.
Register children and women
for Immunization, ANC,
PNC, Health Check ups etc.
Assist in organizing Village
Health Day.
Help AWW in registering
children and women for
Immunization, ANC, PNC,
Health Check ups etc.

4. – Mobilize beneficiaries (with Mobilize beneficiaries for the

the AWH/ASHA) for the Village Health Day under the
Village Health Day through guidance of AWW.
SHGs, Mothers Committee,
beneficiaries of the ICDS
Scheme.

5. Attend to such referred cases on Refer sick children, pregnant/ Refer cases to sub-centre,
priority lactating mothers to sub- PHC/CHC
centre, PHC/CHCs

6. Impart Health & Hygiene
Education to the beneficiaries of
Kishori Shakti Yojana (KSY) /
Nutrition Programme of Adoles-
cent Girls (NPAG).
Assist CDPO/ICDS Supervisor Assist AWW in her activities
in implementation of Kishori pertaining to KSY & NPAG.
Shakti Yojana (KSY)/Nutrition
Programme of Adolescent
Girls (NPAG)

7. – Depot Holder of Medicine Receive ASHA Kits /

Kit/Contraceptives of ASHA & Contraceptives from AWW.
under ICDS.

8. Administer such drugs as specified Administer OTC drugs Distri- Administer OTC drugs Distri-
by the M/O HFW bution of ORS/IFA Tabs, DDK, bution of ORS/IFA Tabs, DDK,
OP & Condoms. OP & Condoms.

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S. No. ANM AWW ASHA

9. Implement IMNCI. Home Visits-Once a month Implement IMNCI. Home vis-

Home visits once in two months during pregnancy, Once in its at least once in a month
during pregnancy. (Once in the the first week of delivery. during pregnancy. (Once in
first week of delivery) Second visit in second or the first week of delivery).
third week as per the need.

10. Maintain and Update Eligible – Help ANM to maintain and

Couple Register. update Eligible Couple
Register.

11. – Counsel women on birth pre- Counsel women on birth pre-

paredness paredness

12. Guide/Counsel women on safe/ Guide/Counsel women on Assist ANM/AWW in this

institutional delivery. safe/institutional delivery. work.

13. – – Assist /Escort women for in-

stitutional delivery.

14. Guide TBA (Trained Birth – Guide TBA (Trained Birth At-
Attendant) tendant)

15. – – Facilitate referral of difficult

cases.

16. Nutrition & Health Education Nutrition & Health Education Nutrition & Health Education

17. Promote breastfeeding of Infant & Promote breastfeeding of In- Promote breastfeeding of In-
Young Child Feeding Practices. fant & Young Child Feeding fant & complementary Feed-
Practices. ing Practices.

18. Share available information with Share available information Ensure registration of all
the Village Registrar of Births & with the Village Registrar of births and deaths of mothers
Deaths. Births & Deaths. with the Village Registrar of
Births & Deaths.

* Please note that in addition to the above listed activities, ASHA will also play an active role in preventive
and promotive activities of all health programmes in the village, including communicable and chronic
diseases. She will be guided and monitored both by the ANM and the AWW. The Anganwadi Centre will
form the base of her activities.
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1.7 How to Start and Organise an Anganwadi
Centre?
An AWW has the responsibility of starting and setting up an Anganwadi
Centre (AWC).

A. Location

Location of an Aganwadi is important
for proper utilisation of ICDS services.

An AWC should be located at a place
which is easily accesible, away from
congested or traffic areas, does not
have ponds or rivers or other dangerous
places nearby, and is near the locality
of weaker sections of the society.
B. Building

Local community should provide
accommodation for running an AWC
free of rent. In this way the community
can be involved in ICDS programme
right from the beginning.

Most of the time, in rural and tribal
ICDS projects, the community either
provides a room / building for running
an Anganwadi free of rent or get a
room constructed for the same.

If the local community is not able to
arrange a rent free accommodation for
Anganwadi, the AWW should contact
the community leader for arranging the
accommodation on rent.

Anganwadi building can also be
constructed by utilising the National
Rural Employment Programme funds
and a grant of Rs. 1500/-(commuted
rent for 5 years) from ICDS Scheme or
contribution in cash or kind from the
community & other sources.

An AWC can be in a pucca / semi –
pucca building.

Points to Remember

Well ventilated room to accommodate 40 children for sitting as well as indoor activities.

Space for storage of play equipment & material.

Space for cooking and storage of kitchen equipment & food.

Arrangement for safe drinking water supply and toilet facilities.

Sufficient open space for outdoor activities.

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C. Equipment

The basic equipment required in an AWC is sent by a CDPO. In case it

is not received, an AWW should contact concerned Supervisor / CDPO.

Items for General Use Kitchen Equipment

a) Tumblers, plates and spoons
a) Small mats or durries
b) Two or three vessels with lids for cooking
b) One closed shelf for c) Stove with kerosene oil
storing equipment
c) One or two wooden racks Bathroom Equipment
a) Two buckets or vessels for storing water
d) Low wooden chair and table for Anganwadi b) Two mugs
worker.
c) Two soap containers
e) Weighing Machine d) Four towels
e) Disinfectant fluid
f) First aid box and medicines for common
ailments f) Brooms, brushes and other cleaning
material.
g) One locally made mud vessel (with a tap
and lid) for keeping drinking water Indoor Play Equipment
h) A National Flag a) Wooden building blocks of different sizes
b) Counting frames
i) Files, registers and records
c) Paints, brushes and coloured chalk sticks
j) Mother and Child Protection cards / growth d) One dholak (beating drum)
chart register e) Three scissors

D. Supplies and Material

Play Material

AWW can prepare the following PSE material from locally
available resources with the help of community members

Indoor Play Material Outdoor Play Material

1. Puppets 1. Simple swings from locally available
2. Doll’s House ropes,cycle tyres etc.
3. Flash cards for story telling 2. Sand Pit
4. Models of animals, fruits, vegetables etc. 3. Small mud pots for growing plants.
from card or mud.
5. Blocks from card board
Preschool Education (PSE) Kit
6. Charts
7. Stuffed Dolls 1. An AWC is given a PSE Kit by the State
Govt.
8. Drums made out of waste tin boxes
9. Rattlers from soda water lids etc. Medicine Kit
10. Colour, number and alphabets matching 1. An AWC is given a Medicine Kit by the
card from card board. State Govt.

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1.7.1 Activities at Anganwadi Centre (AWC)

An AWW should plan and organise activities at AWC in such a manner

that all the ICDS services are delivered covering all the beneficiaries in
the village

An Anganwadi is expected to run an AWC for 4 1/2 hrs. The timings of AWC should be
according to the convenience of the community.

An AWW should open and close AWC on time.

An AWW and the Helper should daily reach Anganwadi before time for the following
activities:
a) Cleaning of the Anganwadi
b) Supply of drinking water.
c) Making arrangements for PSE activities.
d) Cooking supplementary food (If required) or keeping the food ready for distribution.

Monthly / Quarterly / Periodical Ac-

Daily Activities at AWC
tivities at AWC

a) Inspection of children for cleanliness. a) Health check up of children and mothers

b) Organising Supplementary Nutrition for
children and expectant and nursing
mothers.
c) Washing hands of children before and
after taking Supplementary Food.
d) Organising Preschool Education
activities.
e) Treatment of common childhood
illnesses & minor ailments.
f) Referral Services as and when required
b) Immunization (As per the schedule)
c) Weighing children and Growth Monitoring
(Once in a month)
d) Distribution of Vitamin A and Iron Folic
Acid tablets
e) Organising mother’s meeting
f) Preparing Monthly Progress Report
(MPR)

g) Conducting Home Visits. g) Updating Family Survey Register

h) Record Keeping.

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1.7.2 Expected Time for Daily Activities at AWC

An AWW should adhere to the time allotted for health, nutrition and
education activities so that all the services are provided to the
beneficiaries

Daily Tasks Expected Time

Preschool Education 2 Hours (120 min.)

1
Preparation and Distribution of /2 Hour (30 min.)
Supplementary Nutrition

1
Treatment of Common Childhood Illnesses/ /2 Hour (30 min.)
Ailments & Referral

1
Filling up Records and Registers /2 Hour (30 min.)

Making 2-3 home visits 1 Hour (60 min.)

TOTAL 41/2 Hours (270 min.)

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1.8 Training of ICDS Functionaries and Trainers

NIPCCD is an apex Institute for planning, coordination and monitoring training of ICDS
functionaries and trainers.

NIPCCD has the responsibility of cutting Training Institutes (STIs) have been
edge training, training of CDPOs / identified.
ACDPOs, building - up capabilities of

All the ICDS functionaries i.e. Helpers,
institutions engaged in training of ICDS
Anganwadi Workers, Supervisors and
functionaries; organising training of
trainers; designing, revising, CDPOs are given initial job training,
standardising and updating syllabi, and then refresher training and
preparation of training modules; and innovative / skill training from time to
preparation, procurement and time.
dissemination of training material.

UDISHA has redefined ICDS training.

In the country, there is a net work of UDISHA in Sanskrit means the first rays
Institutes for training of ICDS of new dawn. It is the nation wide training
functionaries & trainers comprising component of the World Bank assisted
Middle Level Training Centres (MLTCs)
Women and Child Development Project
and Anganwadi Workers Training
which is being implemented since 1999.
Centres (AWTCs). In a few States, State

24
 Training of ICDS Functionaries and Trainers
Category Total Working Training Institute
Duration Days

ICDSFunctionaries
* JTC for CDPOs / ACDPOs 32 26 NIPCCD Head Quarters (HQs),
Regional Centres (RCs) & State
Training Institutes (STIs)
* JTC for Supervisors 32 26 Middle Level Training Centres
(MLTCs)
* JTC for AWWs 32 26 Anganwadi Workers Training
Centres (AWTCs)
* Induction Training of 7 5 NIPCCD HQs, RCs and STIs
CDPOs/ACDPOs
* Induction Training of 7 5 MLTCs
Supervisors
* Induction Training of AWWs 8 6 AWTCs
* Orientation Training of Helpers 8 6 AWTCs
* Refresher Training of 7 5 NIPCCD HQs, RCs and STIs
CDPOs/ACDPOs
* Refresher Training of 7 5 MLTCs
Supervisors
** Refresher Training of AWWs 6 5 AWTCs
** Refresher Training of Helpers 5 4 AWTCs
Trainers of AWTCs and MLTCs
* Orientation Training of 12 8 NIPCCD HQs & RCs
Instructors of MLTCs / STIs
* Orientation Training of 11 8 MLTCs
Instructors of AWTCs
* Refresher Course for 7 5 NIPCCD HQs & RCs
Instructors of MLTCs and STIs
* Refresher Course for 7 5 MLTCs
Instructors of AWTCs

* Inclusive of one day before and after the course and exclusive of holidays falling during the course except
Sunday
** Inclusive of half a day each before and after the course.

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1.9 Kishori Shakti Yojana

Kishori Shakti Yojana caters to 40 Adolescent Girls in the

age-group of 11-18 years. The

Under ICDS Programme, since 2000, Anganwadi Worker is the regular
Kishori Shakti Yojana (KSY) is being honorary instructor for the Balika Mandal
implemented to empower adolescent girls and provides general education and
so as to enable them to grow and develop literacy to adolescent girls. Instructors
to take charges of their lives. of AWTCs and MLTCs and training
centres of Health and Family Welfare

KSY is redesign of the already existing
Department are enlisted for visiting Balika
Adolescent Girls Scheme being
Mandals from time to time to provide
implemented since 1992 using ICDS
continuing education. These girls
infrastructure. The Scheme comprised
participate in the activities of Balika
two subschemes i.e. Girl to Girl Approach
Mandal and are provided with
for Adolescent Girls in the age group 11-
supplementary nutrition equivalent to the
15 years and Balika Mandal to reach
entitlement for a pregnant/lactating
Adolescent Girls in the age group 11-18
woman for 6 days in a week.
years.

KSY is being implemented through AWCs

Under Sub-Scheme I, at a time, 3
in rural and urban settings in all the
Adolescent Girls are attached to AWC
6118 of ICDS blocks.
for 6 months. They receive 3 days basic
training from a Supervisor followed by
one day session every month so as to
become capable of managing the centre
on their own. During this period, they
assist AWW in delivery of services also.

Under Sub-Scheme II (Bilika Mandal),

Twenty girls in the age-group of 11-18
years are identified from all eligible girls
in the anganwadi centre. Only 10% of
the total AWCs in an ICDS Project are
selected to serve as “Balika Mandals”.
All the 20 girls are enrolled for a period
of 6 months in the Bilika Mandal. Thus
during the year, each Balika Mandal

26
 The following Activities are conducted
in KSY Schemes

* Adolescent Girls Scheme I 1. Simple and Practical messages on

Girl to Girl Approach * Preventing health, hugiene, nutrition
(11-15 yr old girls) and education

* Working of the anganwadi center

* Family life educationa

2. Supplementary nutrition

Adolescent Girls Scheme-II 1. Learn about significance of

Balika Mandal
(11-18 yr old girls) * Education and life skills
* Personal hygiene
* Environmental sanitation
* Nutrition and Home nursing
* First aid, communicable diseases,
vaccine-preventable diseases
* Family life, child care and develop
ment Constitutional rights and their
impact on the quality of life

2. Participate in creative activities and

learn through the sharing of experi
ences and discussions of issues that
affect their lives.
3. Skill development
4. Supplementary Nutrition

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Objectives of KSY

Improve the nutrition and health status of girls in the age group of 11-18 years.

Provide the required literacy and numerate skills through the non- formal stream of
education, to stimulate a desire for more social exposure and knowledge and to help them
improve their decision making capabilities.

Train and equip the adolescent girls to improve/upgrade home based and vocational skills.

Promote awareness of health, hygiene, nutrition and family welfare, home management and
child care, and to take all measures so as to facilitate their marrying only after attaining
the age of 18 years and if possible, even later

Gain a better understanding of their environment related social issues and the impact on
their lives; and

Encourage adolescent girls to initiate various activities so as to become productive and

useful members of the society.

KSY has a number of programmatic options for States / UTs based on the area-specific
needs and requirements. States can select the programme interventions that respond
best to the local context.

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 Early Childhood
Care & Development

29
30
 PART 2
Early Childhood Care & Development
Page

2.1 Child Development, Definition, Process 32

and Characteristics

2.2 Enhancing Early Childhood Learning & 43

Personality Development

2.3 Early Childhood Care & Education 46

Services in ICDS

2.4 The Preschool Child 52

2.5 Activities for Preschool Education at AWC 53

2.6 Planning and Organising PSE Activities at AWC 75

2.7 Illustrative Plan for a Day for Preschool 79

Education Activities at an Anganwadi Centre

2.8 Basic Minimum Kit of Play Material for 80

Preschool Education Programme

2.9 Anganwadi – A Centre for Joyful Learning 83

31
2.1 Child Development, Definition, Process and
Characteristics
2.1.1. Who is a Child?

Asper the Constitution of India, a person
below 14 years is a child.

The Census of India also considers a person
below 14 years as a child.

As per the Convention on the Rights of the
Child (CRC), a child means every human
being below the age of 18 years.

In India, the definition of a child varies with
purpose and specific legislation. The
Government of India is considering adopting
the definition of the child as stated in the Convention, wherever it is feasible and applicable,
so that the rights of children are protected in the society under all circumstances.

2.1.2. What is Child Development?

Child Development is the process of growth and development of a child over a period of
time and explains how and why it occurs.

Child Development extends from the moment of conception to the pubescent comprising
changes in all round development of the child at each stage.

Child Development focuses on the pattern of development and the role played by
environment and learning experiences.

32
2.1.3. Why Early Childhood is Important?

Development of a child during the first year lays the foundation for the rest of life.

Early development is more critical than later development or is the ‘critical period’, as
childhood is the time when particular good or bad characteristics are slowly and clearly
developed.

Considerable learning takes place during early childhood which prepares the child for
adulthood.

Easy to guide children in the right direction and inculcate good habits and moral values
during early childhood than at a later stage.

Easy to make children outgrow undesirable habits and traits early in life than when they
grow up. Habits formed during early childhood influence later behaviour.

Experiences during early childhood have an impact on the ways of thinking and behaviour
in adulthood.

33
 Adolescence
10-19 years
2.1.4. Stages of Child Development
Childhood
2-10 years
Infancy
Birth – 2 years Rapid increase in height and
weight and personality
development

Early Childhood (2-6 years) - muscular and

Prenatal mental coordination, social development
Conception to Birth and self reliance
Late Childhood (6-12 years) – Socialisation,
Rapid growth of body and personality development and rapid social
34

mental abilities. and emotional development

Extremely rapid growth,

physiological development and
growth of all bodily structure

Childhood is divided into four major stages beginning from conception to when the child
becomes sexually mature. These are:
i. Prenatal – Conception to birth
ii. Infancy – birth to 2 years
iii. Childhood – 2–12 years
iv. Adolescence – 12–18 years

Each of the four stages are characterised by differences in physical, mental, language,
social and emotional abilities of an individual.

Change from one stage to the other is a gradual and a continuous process.
2.1.5. Aspects of Child Development

Child Development is holistic in nature i.e. a child develops as a whole.

All round development of a child comprises three major aspects or areas or domains.
These are:
1. Physical and Motor Development
2. Cognitive and Language Development
3. Psychosocial Development

Development in each of the three aspects does not occur independently, infact it is
interdependent.

The affect of development in each area can not be separated out easily as each affects the
development of the other.

Experiences and achievements of a child in the three areas of development contribute
towards developing a child’s personality.

Physical and Motor Development

Physical Development – Changes in body’s size, structure,

proportion and system


Motor Development – Development of control of muscular
functions and coordination between various parts of the body

Psychosocial Development
Development of emotions and social bonds

Social Development – Ability to relate to others and behave

in accordance with the expectations of the society

Emotional Development – Ability to feel, regulate and
express emotions

Cognitive & Language

Development

Cognitive Development – Ability to think, perceive and

solve problems including intellectual development i.e.

development of language and thinking skills

Language Development – Ability to communicate and speak

35
 Factors Influencing Growth & Development

Environment
Heredity (Genes)
Family Structure &
Relationship
Prenatal Environment
Early Stimulation and
Learning Experiences

Maturation & Learning

Child Rearing
Practices,
Growth & Development Attention
36

-Result of an interaction & Love

between heredity and
Position of the environment.
Child in the
Family Social Environment

Sex of the Child Psychological

Environment

Birth Spacing Health &

Economic Condition Nutrition Care
2.1.6. Process of Child Development

Child Development is the process of growth & development which involves both
qualitative and quantitative changes.

The process of child development is affected by heredity and environment due to
which a child matures and learning takes place.

Growth & Development
Heredity refers to genes or inborn

Growth refers to quantitative changes i.e.
increase in body size, proportion and
structure, which can be measured
through increase in height, weight and
size of internal organs.

Development refers to qualitative and
quantitative changes related to
functioning of a body. It includes
acquiring skills and abilities to perform
finer and more complex tasks. These
changes are progressive, orderly, long
lasting and coherent. Growth is one
aspect of larger process of development.

Growth stops at a particular age.

Development is a continuous process
that begins during the prenatal period
and continues even when the physical
changes are not visible.

Growth and development are inter-
dependable, for a child to be able to
develop, he or she has to grow.
characteristics or traits a child receives
from the parents and is born with. This
is her/his genetic background.

Environment refers to external
conditions under which a child
develops and include type and quality
of stimulation, experiences and learning
opportunities provided by caregivers.

Maturation is a natural process of
unfolding of characteristics present in
an individual as per his/her genetic
background.

Learning is development that involves
acquisition of skills and abilities and is
determined by environment,
stimulation and experiences.

Maturation and learning are closely interrelated. For full development of heredity
potentials, children must be provided with learning opportunities and stimulation. Similarly,
due to limitations in genetic background, learning cannot go beyond a certain point even
when it is encouraged.

Mother/Caregivers should provide qualitative learning opportunities to children right from
the birth. Children are actively engaged in development through exploration & learning.
Deprivation of learning opportunities due to poverty, parental rejection and lack of early
stimulation limits development.

37
2.1.7. Pattern of Child Development and the Characteristics

Understanding of pattern of child development and its characteristics help to

understand the process of child development

Pattern of Development

All children follow a predictable pattern of development which always takes place in
two directions:
1. Development Spreads Over the Body from Head to Toe. e.g. Head region is the
first to develop followed by trunk & then limbs, in both prenatal and postnatal
development.
2. Development Proceeds from Centre of the Body to the Ends. e.g. Body parts and
muscles which are near the centre of the body develop before the other parts e.g. heart
and spinal cord develop first and fingers & toes at the end.

Your Babys Development

Characteristics of Child Development

Pattern of Development has many common and predictable characteristics

i) Development is Continuous iii) Development of each Child is

Development is a continuous process Unique
from the moment of conception till death Each child is
e.g. Child develops into an adult unique and
ii) Development follows Similar and different from
Orderly Pattern others due to his
genes and
All children follow similar pattern of environmental
development with one stage leading to experiences.
the next and it is always in order.
e.g. Rani and Kumar are sister and brother.
e.g. All babies stand before they start Inspite of being brought up in the same
walking. They cannot walk without family, both are different in looks, nature
standing first. and habits.
38
iv) Development is Progressive viii) Development is from Simple to
Development results in changes in Complex
acquiring skills Development proceeds from simple to
& abilities that complex
are finer and e.g. Similar cells of zygote change to
complex than form tissues like nerves and bones.
the ones that
preceded them. ix) Different parts develop at different
rates
e.g. Crawling leads to walking
Development is never uniform for all
v) Development is Holistic the body parts.
Development takes place in all areas e.g. Feet, hands
at the same time and nose reach
e.g. Along with rapid physical m a x i m u m
development marked by increase in development
height, rapid mental development during early
marked by increase in growth of adolescence and
memory and rapid social development shoulders develop
marked by interacting with family and fully after that.
environment takes place. x) Rate of
vi) Correlation in Various Aspects of development
Development differs from one child to another
Development in one area is linked to There are individual differences in rate
the development in the other. of development due to heredity &
e.g. Along with physical development, environment influences.
mental development is also rapid and e.g. one child may walk at the age of 9
vice versa. months and the other may do so at the
vii) Development is from General to age of 13 months.
Specific xi) Happiness varies at different periods
Development proceeds from general in development
to specific response. Childhood is usually considered the
e.g. Babies wave their arms in general happiest period in life.
before they are able to reach out for
an object held before them.

39
2.1.8. Developmental Milestones

Child’s progress on the path of development across definite stages is marked by certain
indicators called Developmental Milestones.

Milestones are like guideposts for various stages of development, through which every
normal child passes.

Milestones indicate the age at which children are expected to perform tasks which are
also called developmental tasks.

Milestones for growth are easy to measure e.g. height and weight; whereas milestones
for development are more complex and difficult to measure e.g. cognitive, language,
social development, etc.

For every child there is a normal range for completion of a ‘milestone’. But each child
reaches a ‘milestone’ or performs the expected ‘developmental task’ at his own pace
and in his or her own way.

If the child seems slow, increase feeding, talking and playing. If the child is still slow, take
the child to a doctor.

Sometimes, a stage is skipped or another one is delayed. And, some children progress
more rapidly than the others. But this need not be a cause for alarm. If accomplishment of
‘milestones’ is unduly delayed, it is a signal that a child should be medically examined.

Parents or caregivers should be aware of the ‘developmental milestones’;

so as to know whether the child is making normal progress or something
is wrong or there is a disability.

40
 Milestones of Development

Age Milestones of Development

One Month

Cries in hunger or discomfort

Turns her or his head towards a hand that is stroking the
child’s cheek or mouth

Brings both hands towards her or his mouth

Turns towards familiar voices and sounds

Suckles the breast and touches it with her or his hands

Three Months

Smiles

Begins to make cooing sounds like ‘ooh’ and ‘aah’

Turns head towards bright colours and lights

Holds head erect and reaches for an object

Recognises mother & members of family

Makes fists with both hands

Wiggles and kicks with legs and arms

Six Months

Holds head steady when held upright

Raises the head and chest when lying on her or his stomach

Reaches out for dangling objects

Turns to a sound or a voice.

Grasps and shakes objects

Rolls both ways

Sits with support

Responds to her or his own name and to familiar faces

Explores objects with hands and mouth
Nine Months

Sits up from lying position

Picks up with thumb and finger

Sits without support

Crawls on hands and knees

One Year

Stands without support

Tries to imitate words and sounds

Waves Bye-bye

Enjoys playing and clapping

Says Papa and Mama

Starts holding objects such as a spoon or a cup and attempts
self-feeding.
41
 Milestones of Development

Age Milestones of Development

Eighteen Months

Walks well

Expresses wants

Stands one foot with help

Points to objects or pictures when they are named
(e.g. nose, eyes)

Starts saying names of objects

Puts pebbles in a cup
Two Years

Walks, climbs and runs

Says several words together

Follows simple instructions

Scribbles if given a pencil or crayon

Enjoys simple stories and songs

Imitates the behaviour of others on household work

Begins to eat by herself or himself
Three Years

Walks, runs, climbs, kicks and jumps easily

Recognises and identifies common objects and pictures by pointing

Makes sentences of two or three words

Says her or his own name and age

Can name colours

Can understand numbers

Uses make-believe objects in play

Expresses affection

Feeds herself or himself
Four Years

Balance on one foot

Plays simple games with others

Asks questions

Answers simple questions

Shows different emotions

Recognises to six basic colours

Washes hands alone
Five Years

Moves in a coordinated way

Speaks in sentences and uses many different words

Understands opposites (e.g. fat and thin, tall and short)

Plays with other children

Dresses without help

Answers simple questions

Counts 5 to 10 objects

Washes her or his hands.

42
2.2. Enhancing Early Childhood Learning & Per-
sonality Development
During early childhood, if a child has stimulating environment with a variety of
learning experiences and opportunities to move and explore, learning and
development is enhanced.

Babies begin to learn from the moment they are born.

Babies learn faster when their basic needs like physical care,
security, stimulation and love are met on time.

Early stimulation and learning activities are based on
prevalent child rearing practices. They include play, music,
games, stories, outings etc. with focus on creating an
environment to give children freedom, opportunities and
incentives.

Learning experiences are to be given right from the birth
and should involve activities that have a closer interaction
between the child and the parents.

Best stimulating environment is provided by the family.

Family is the child’s first social unit or first place of
interaction with the environment.

Family has a major role to play in meeting child’s needs; providing a stimulating
environment to enhance learning and development; and develop the child’s personality.

Early childhood care is the care provided to a young child in an integrated and holistic
manner, with the rights perspective, leading to his/her survival, growth, development
and protection, through child centered, family focused and community based
interventions.

Physical care of a child includes food, sleep, rest, clothing, exercise etc.

Stimulation is any activity that causes the child to respond and activate early learning
and development.

How a Young Child Learns?

Children construct their own knowledge through
repeated interaction with people and material.

Children learn through social interaction with
adults and other children.

Children’s learning cycle begins with awareness
and moves to exploration, inquiry and finally
utilisation.

Children learn through play

Children learn how to behave by imitating the behaviour of ones closest to them.

Each child has an individual style of learning.
43
 Factors influencing Child’s Personality
44
 Family’s Role in Development of Children
The Family:

Gives feeling of security and acceptance.

Meets physical, psychological and emotional needs.

Source of affection, love and warmth.

Set models for social behaviour.

Teaches moral, social and cultural norms & values.
Gives:

Guidance & support for learning skills.

Provides stimulating environment for learning and development.

Makes house a pleasant home.

Development of Child’s Personality

Personality is the quality of a person’s total behaviour. Personality reflects what one is and
refers to a person’s characteristics.

Personality includes the whole individual, his physique, temperament, skills, interest, habits,
feelings, pattern of thinking, intelligence, achievements, concept of one’s self and ways of
relating to others.

Personality is mainly affected by three major factors:
– Heredity
– Environment
– Learning Experiences and Aspirations

Personality has two major components i.e. ‘Self Concept’ and ‘Traits’.

Self concept is what a child thinks of himself and what he is. It is determined by his role
and relationship with others.

Traits are specific qualities of behaviour of an individual and are influenced by self
concept.

Personality of each child is unique and is responsive to many factors including good
parenting.

45
2.3 Early Childhood Care & Education Services
in ICDS

Early Childhood Care and Education (ECCE) is one of the important services provided
under ICDS Programme

ECCE component of ICDS is;
→ a significant input for providing a sound foundation for child development
→ contributing towards preparing the child for primary school
→ offering substitute care to the younger siblings, thus freeing the older children – especially
girls – to attend school.
→ a move towards universalisation and qualitative improvement of primary education.

ECCE component of ICDS includes two types of services i.e.:
i. Early Childhood Stimulation (Children below 3 years)
ii. Non-formal Preschool Education (Children 3-6 years)

Preschool Education activities are built on local and cultural practices, using locally
available material developed by an AWW.

2.3.1 Early Childhood Stimulation: Concept, Need & Activities

Early Childhood Stimulation (ECS) is an effort to development among children below
3 years.

ECS aims at providing learning experiences to the child for his/her holistic development.

ECS includes activities that help the child to know his environment.

Significance of Early Childhood Stimulation

Ensures healthy development of the child

Develops basic trust and emotional security

Stimulates intellectual curiosity

Enhances language development

Develops basic values of sympathy, tolerance, helpfulness and
kindness.

Provides opportunities to explore and develop

Gives security and acceptance

Encourages children to play

ECS becomes effective with close interaction between the child and
the mother or caregiver.

46
 Early Childhood Stimulation Activities for Children
below 6 months

Physical Language Personal Cognitive

and Motor and Social

Shake a rattler in
Hold the child in
Hold the child
Hang pictures,
front of the child or your arms and talk close to you when coloured paper and
clap your hands to him she cries, give love coloured wooden
above the head to and affection objects over the
make him lift head
When child makes cradle.
to look up. sounds, talk to him
Have eye to eye
as if you are contact and smile at
Make toys using

Cover the child’s answering the child frequently. beads, bottle caps,
face with cloth and bells, rings etc.
remove immediately
Sing songs and
Feed the child in a which make sound
and say ‘a-ha’. The lullabies before playful manner and hang near the
child will respond by dressing and when 6 months old child so that he can
kicking his / her sleeping time. see and hear them
arms.
Respond to smiles

Move around and and cooing, play
Walk with your

Bring one finger of show her things cuddling and child in your arms
the hand close to around and name feeling games. around the house.
child so that he them Let the child see the
holds it.
Take the child things around and

Use simple outside home and get familiar with

Encourage the child repetitive words let the child look them.
to roll on her like Dada …. Baba around.
stomach. Nana, Papa
Let the child
explore by sucking,

Give the child grasping and
some toys to play, shaking soft
hold, and grasp if coloured blocks.
he can hold his
head

47
 Early Childhood Stimulation Activities for Children
6-12 months Old

Physical Language Personal Cognitive

and Motor and Social

Make the child sit
Sing
propped up with
pillows

Give the child toys
to play with – Let
her pick up objects

Encourage the child
with one or both
hands

Help the child to
sip water/juice/
milk from a cup/
small glass in sitting
position

Respond positively

Put attractive toy or
ball just in front of the
child and move
forward to encourage
the child to crawl
Repeat whatever

Put some toys on
low stool, so that
the child tries to
hold and stands to
reach for the toys

Use a walker/stool
which the child on
can push and walk

Play clapping
games with the
child – closing and
opening of fingers.
songs,
Hug and hold the
Show him stars,
lullabies and show child close to you – moon, animals,
pictures while show that you love birds etc. move
spending time with her your fingers while
the child showing things

Attend to child
when hurt, sleepy,
Expose the child to
to utter simple wet or hungry various sounds
words like papa,
mama, baba, dada
Sit and play with
Hide a toy behind
and repeat child, simple finger
you and encourage
continuously what games/tickle games
the child to look for
child utters. it

Make the child
familiar to relations
to child when she by calling family
Give the child a
members as nana, box/basket of small
tries to speak and toys and objects to
name things baba, massi etc.
play with. Gather

Take him out up toys in the
the child says by shopping/visiting basket when she
smiling and people throws them.
hugging her

Cover your face
with a piece of
cloth or your hands
and hide and seek
with the child.

48
2.3.2. Preschool Education (PSE) in ICDS: Concept and Need

Preschool Education in ICDS is a child-centered programme for 3 to 6 years old children
which follows the playway activity approach using toys, play equipments etc. which is
of indigenous origin, inexpensive.

PSE activities are organised daily at AWC for about 2 hours.

PSE focusses on holistic development of the child and provides a stimulating play
environment for his/her physical, cognitive, and psychosocial development.

PSE encourages interaction with the environment, active participation in group activities
and promotes problem solving ability in children.

PSE does not have syllabus for teaching the 3 R’s, but lays the foundation for the same
i.e. development of reading, writing and number work.

PSE is flexible to children’s needs and does not focus on school achievements.

PSE programme does not emphasise on passive listening and learning by rote in children.

49
2.3.2.1. Need & Importance of Preschool Education

Preschool Education is important for overall development of the child

as early years are critical in the life of a child.

50
2.3.2.2. Objectives of Preschool Education Programme in ICDS

GOOD PHYSIQUE, muscular

co-ordination, basic motor skills
STIMULATING INTELLECTUAL
CURIOSITY to enable the child
GOOD HABITS AND SKILLS
to understand his environment
for personal adjustment, toilet
by exploring, investigating,
training, dressing, eating,
experimenting and learning.
cleaning, etc.

AESTHETIC APPRECIATION SOCIAL ATTITUDE,

of self, others, things and group manners and
environment sharing things with
others; live & play
PSE AIMS TO with others and
control natural
DEVELOP IN aggressiveness
EMOTIONAL MATURITY
by guiding to express,
THE CHILD and destructiveness

understand, accept
and control PERSONALITY DEVELOPMENT
feelings and emotions. through rich learning experiences.

INCULCATES moral & cultural

values so as to be honest, ABILITY TO EXPRESS THOUGHTS
obedient, truthful and AND FEELINGS in fluent, correct
respect elders.
respect full to elders. and clear speech.
SELF CONFIDENCE
and inner discipline

Preschool Education Programme aims at development of a child as a

whole and includes activities and learning experiences for the same.

51
2.4 The Preschool Child

The Preschool Child is
Explore new things

Curious
Repeat activities, songs, stories etc.

Exploratory The Preschool Child enjoys :

Imaginative

Listening stories

Energetic

Playing games

Innovative

Running, jumping, hopping etc.

Spontaneous

Singing songs

Eager to Learn

Doing Activities in small group

Self-centered

Playing with dolls, water, mud and sand

Having short attention span

Dressing up and acting or role play
The Preschool Child Likes to

Dance, drama and creative movements

Learn through play

Respond to music, rhythm and rhymes
Drawing, painting etc.

Touch, taste, smell, hear and see things.
Exploring things in their environment

The Preschool child must be kept BUSY with a variety of Interesting

activities.

52
2.5 Activities for Preschool Education at AWC

PSE activities in an Anganwadi are planned & organised to promote

holistic development of children

53
2.5.1 Activities for Physical & Motor Development

Objectives

Monitoring growth

Development of gross (large) muscle/motor coordination

Development of fine muscle/motor coordination
– Small muscle coordination
– Eye hand coordination
– Hand to mouth coordination

Role of an AWW

Keep the room uncluttered to allow maximum movement.

Select motor activities in accordance with the child’s stage of development, interests and
needs.

Select a variety of activities to ensure child’s interest.

Maintain a balance between active and passive as well as outdoor and indoor activities.

Ensure that all play equipment and material is intact.

Stay alert during outdoor and indoor free play to prevent accidents.

Ensure that all children get the chance to use the play equipment/material.

Provide short rest period after vigorous activity.

Do not interfere with children’s free play.

Do not compare children’s achievements as each child is different.

54
 Activities for Physical & Motor Development

Gross / Motor Coordination and

Development

Gross Motor Coordination means developing

control over the movement of the large
muscles of the body such as thighs, legs,
torso, shins, arms, etc. Activity includes
outdoor and indoor games and physical
exercises

Walking Skipping Kicking

Running Cycling Swinging
Climbing Catching Relay race
Jumping Throwing Musical chair
Balancing Hopping
Rhythmic movement

Fine Motor Development

Fine Motor Coordination means developing
control over the movement of finer muscles,
particularly finger and wrist muscles and eye-
hand coordination.

Tearing Sewing

Sorting Threading

Painting Collage

Finger painting Cutting

Pouring Buttoning

Paper folding Paper Masche

Fun with pebbles Crushing

Pasting Writing

Drawing Sand & Water play

Pattern making Clay Work

55
 Age-Specific Activities for Gross Motor Coordination and
Development

Activity 3-4 Years 4-5 Years 5-6 Years

Walking Walks along a Walks forward and Walks with ease,

straight line with backward with grace and rhythm,
ease coordination and showing well
ease. coordinated
movement.

Rhythmic Responds to rhythm Responds to the Does simple dance

Movement or beat while rhythm or beat with movements in tune
clapping. body movement like with and to the beats
swaying, jumping, of music.
clapping, etc.

Throwing a Ball Aims and throws the Throws a ball at a Throws a ball at a
ball freely in a given given target more given target with
direction. accurately. accuracy and plays
specific games for
example bat and ball.

Hopping Hops at a single spot Hops for a longer Hops for some
once or twice. time on both feet and distance with ease
even move a short and speed.
distance.

Climbing-Ascending Climbs up and down Climbs up and down Climbs with

and Descending taking a support. using alternate feet confidence and
speed.

56
 Age-Specific Activities for Fine Motor Developmen
Development

Activity 3-4 Years 4-5 Years 5-6 Years

Tearing – Cutting – Crumple and tear Cut paper along Tear and cut paper
Pasting paper at random and straight lines, forming into finer pieces and
paste the pieces in a simple shapes like different shapes and
large outline, though square, rectangle, paste them neatly
not very neatly. triangle, etc. according to the
design in smaller
area.

Threading Puts a stiff wire or Puts a stiff wire or Puts a stiff wire
thread through large thread through through holes
holes smaller holes arranged in complex
order or design.

Clay Work Beat or pat the clay, Mould clay into Mould clay into more
pull it apart and various simple complex and
mash it together. shapes and meaningful shapes
decorate with other and objects.
accessories like
twigs, colour,
flower, petals, etc.

Paper Folding Simple folding Makes more Make still more

activity using palm complex shapes by complex and neat
and fingers to form folding paper. shapes through
a square or folding activities.
rectangular piece.

Drawing – Scribble with Draw recognizable Draw many

Colouring – Painting enjoyment, draw figures and meaningful figures
lines and copy meaningful and shapes.
circles. drawings with
crayons.

57
2.5.2 Activities for Cognitive & Language Development
2.5.2.1 Cognitive Development
Cognitive Development is the development of those basic mental skills which help a child in
getting to know and understand the environment.

Objectives
A. Development of Basic Cognitive Skills

Development of Five Senses
(a) Sense of sight
(b) Sense of hearing
(c) Sense of touch
(d) Sense of smell
(e) Sense of taste

Memory and Observation
– Increase observation skills and
power
– Increase retention ability
– Develop team spirit.

Classification
– Identify objects on the basis of
concepts or dimensions
– Able to relate to the environment
Role of an AWW

Sequential Thinking
– Stimulate thinking and imagination
Create a stimulating environment for
– Systematic thinking approach children to match, classify, seriate,
– Sharpen observation skills sequence, hypothesize, and experiment.

Reasoning and Problem Solving

Encourage children to observe and
– Understand relationships
describe during nature walk/excursions.
– Increase observation power and
imagination
Encourage the children to ask questions
– Able to solve problems by answering them.
B. Development of Basic Concepts

Give children opportunity to think

Concept of Colour
creatively and solve problems.

Concept of Shape

Development of Pre-mathematical
Provide opportunity to develop skills.
Concepts

Be alert to children’s reaction.
– Concept of prenumber
– Concept of number, space, time and
Let children use the play material. Do
temperature not keep all material stacked away from

Concept of Environment the children.
–natural, physical and social.

Do not expect all children to be alike
and respond in the same way.

58
 Activities for Development of Basic Cognitive Skills
The Five Senses
Children learn through the five senses. Any kind of sensory
limitation may lead to incomplete concept development.

Sense of Touch Sense of Taste

Identify and distinguish between (Salt, Sour, Sweet and Bitter)
different textures i.e. rough/smooth,
Match and identify different tastes
hard/soft, wet/ dry
Recall food stuffs of familiar taste

Name classify and seriate different
textures by using
– Touch cards/Sorting
– Match and identify different tastes
– Recall food stuffs of familiar taste
objects.
– Feely bag.

Sense of Smell

Discriminate between good & bad smell

Recall smell of familiar objects

Identify objects/picture cards of similar
or different smell

Sense of Sight

Match , identify and recognise pictures,
objects, alphabets and numbers

Sense of Hearing

Identify, seriate and discriminate
between common sounds

59
 Activities for Development of Basic Cognitive Skills

Memory and Observation Classification, Grouping &

Memory games Categorisation

Sorting objects and putting in a basket

Identification of missing part of a picture/
object
Matching pictures, seeds, flowers,
objects, etc.

Difference in two identical pictures
Sorting and grouping of objects on the
basis of colour, shape and size.
Sequential Thinking

Identify and categorise cards of

Making patterns using objects like vegetables, fruits, colours, shapes etc.
pebbles, leaves, flower in forward and
Classification cards
reverse sequence

Telling & retelling stories in logical
sequence.

Telling steps of an activity e.g. washing
clothes

Sequential thinking cards

Arranging story cards in a sequence

Reasoning and Problem Solving

Relationship games

Simple mazes/puzzles

Posing problems and finding solutions

Cause and effect questions e.g. what will
happen if it rains?

60
 Development of Basic Concepts

Concept Formation

Concept is a mental construction of a picture, of a class of objects, people, places and

phenomenon.

Clarity of basic concepts enables a child to observe, discriminate and categorise.

For development of any concept, activities should be planned in the following sequence:
1. Matching
2. Identification
3. Naming
4. Seriation
5. Classification

Development of Basic Concepts include:
1. Concept of Colour
2. Concept of Shape
3. Premathematical Concept
a) Development of Prenumber Concept
Size : Big – Small Thickness : Fat-Thick-Thin
Length : Long – Short Width : Wide-Narrow
Weight : Heavy – Light Quanitity : More-Less
Height : Tall – Short Distance : Far-Near
b) Development of Number Concept
Counting 1-10
Many-Few
c) Development of Concept of Time
Before : After
Morning : Night
Yesterday : Today : Tomorrow
d) Development of Concept of Space (Direction and Position)
Up : Down Front : Back
In : Out Before : After
Above : Below Right : Left
Over : Under
e) Development of Concept of Temperature
Hot : Cold
4. Concept of Environment
– Natural Environment

Animal
Birds
Insects
Vegetables & Fruits
Plants
– Physical Environment

Water
Air
Sky
Earth
Weather / Season
– Social Environment

Self and Family
Transport
Community Helpers
Festivals

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 Activities for Development of Basic Concepts

Concept of Colour

Colour Dominoes (matching)

Colour Blocks

Granny’s Parcel

Colour name, games, rhymes and
riddles

Colour Cards

Play activities with coloured beads

Painting

Free Conversation

Story Telling

Concept of Shape

Shape Dominoes (Circle, Square,
Triangle, Rectangle)

Shape Games

Shape Cards – Matching/
Sorting/ Classification

Free & Structured Conversation

Free Play

Clay Work

Tearing & Pasting activities

Drawing, Painting & Tracing

Premathematical Concepts

Prenumber Concept Number Concept

Free Structured Conversation related to
Number Blocks
various dimensions of objects, Rhymes
Counting 1-10
& Story Telling

One to one correspondence

Free Play with objects of various
dimensions
Matching Cards

Pairing Cards – cards with different
Number Cards/Puzzles
dimensions
Number Rhymes, Songs and Stories

Sorting, pairing and grouping of
Number, Names and Order, Games and
pebbles, leaves, sticks etc. according Cards
to dimensions.

Sand Play – Making number on sand

Seriation Card for each Prenumber
Concept with stick or fingers

62
 Activities for Development of Basic Concepts

Concept of Time

Picture Cards

Time Perception Cards

Read the Time

Making a clock

Free conversation/discussion of routine
activities at home

Dramatisation

Rhymes and Songs

Story Telling.

Teaching concept of coming to AWC
on time

Concept of Space

Circle games like ‘In and Out’, ‘Turn
About’, ‘Up-Up-Up’, ‘Down-Down’,
‘Moving in a Circle’

Free Conversation

Story Telling

Rhymes/Action songs

Dramatisation

Picture Cards showing objects in
different positions.

Arranging objects/things from left to
right

Concept of Temperature

Simple experiments with hot and cold
water; freezing and melting of ice,
candle melting etc.

Rhymes and Songs

Open ended question – answer session

Picture Reading, Story Telling, Picture
Cards

63
 Concept of Environment

Natural Environment

Nature Walk – Awareness of natural environment

Free & Structured Conversation during walk in a garden

Charts of Animals, Birds, Insects, Vegetables, Fruits & Plants

Picture Cards

Pairing and Matching Cards

Puzzles related to Animals, Vegetables, Plants etc.

Simple experiments like sprouting of seeds, watering plants etc.

Stories, Rhymes & Songs related to natural environment

Painting, Colouring & Tracing

Physical Environment

Structured Conversation related to physical
environment

Picture Charts

Water Games in a tub of water

Simple Experiments showing use, shape & colour of
water; use & importance of air

Rhymes, Songs & Stories related to water, air, sun,
moon, stars & season.

Simple Questions & Answers Session

Social Environment

Free & Structured Conversation related to themes – Self & Family, Transport, Festivals
etc.

Dramatisation

Doll’s Play

Reading Picture books

Picture Charts

Story Telling & Songs

Celebration of Festivals and National Days & Creative
activities like making diyas, rakhis, national flag etc.

Display of pictures related to festivals

Question – Answer Session

64
2.5.2.2. Language Development

Objectives

Development of Listening Skills
– Sound discrimination
– Listening span
– Listening comprehension.

Development of Vocabulary related to
– Body
– Home
– Environment

Development of Oral Expression
Language learning lays the
– Conversation
foundation for later learning
– Story telling
– Dramatisation
Role of an AWW
– Puppet play

Provide opportunities and
– Picture reading
encouragement to verbalise
– Creative self expression. experiences while doing an activity.

Development of Reading Readiness
Try to introduce variety into
children’s experiences
– Auditory/sound discrimination

Talk a lot with children during
– Visual discrimination
activities.
– Auditory-visual association
Children do not expect to sit quietly
– Left to right directionality. and listen to you all the time.

Development of Writing Readiness
Encourage children to speak in full
sentences.
– Fine muscle development

Provide opportunities to interact by
– Eye-hand coordination working and playing in small groups.
– Letter perception.
Listen patiently to children and
answer the queries.

Encourage the quiet/shy child to talk
Language used in Preschool by praising him and giving attention.
should be the regional
Do not snub or correct a child
language or the mother tongue abruptly if he speaks incorrectly. Just
of the child. repeat the correct form.

65
 Activities for Language Development

Listening Skills
Story Telling Sound Box
Chinese Whisper Rhyming Words
Odd man Out Songs and Rhymes
Who is at the door?

Development of Vocabulary
Picture Reading Story Telling Quiz or Q/A Game
Nature Walk Gardening Water Play
Naming Body Parts

Development of Oral Expression

Free Conversation Picture Reading
Story Telling Doll Play
Dramatization Riddles
Puppet Play Antakshari
Picture Word Matching Nature Walk
Show & Tell Free Play

Reading Readiness Activities

Card Game Rhyming Words Odd man out
Picture Reading See & Tell Matching Cards

Writing Readiness Activities

Activities using brushes, pencils, crayons etc.

Colouring in enclosed spaces

Joining dots

Tracing

Copying Forms

Pattern Making

Children learn language by imitating others; through encouragement

from others; and by expressing ideas, thoughts and feelings.

66
 Activities for Language Development

Category Activity 3-4 Years 4-5 Years 5-6 Years

Listening Skills Following Follows Follows two to Follows three or

Instructions one instruction three simple more instructions
at a time instructions at a at a time
time

Development Identify and Name birds, Name things and Name things
of Vocabulary name things in fruits, vegetables, their use e.g. and their use
the environment etc. birds and their and function in
nest the environment
e.g. parts of a
plants.

Development Recite a Recites a simple Recites a simple Recites a long

of Oral rhyme/poem and small rhyme and small rhyme rhyme with
Expression with some action with complete complete actions
actions.

Reading Picture reading Identifies and Describes Can indicate

Readiness name objects objects and the theme of
what they are the picture and
doing create a story.

Writing Joining dots Can join a few Can join dots in Can join dots to
Readiness dots different shapes make different
and design shapes and
using crayons designs.
or chalk on
paper, slate or
sand.

67
2.5.3 Activities for Psycho-social Development

Objectives

Development in relation to self
– Adjustment to AWC & enjoy
preschool activity
– Positive self concept
– Good personal habits
– Qualities of initiative, independence
and self confidence
– Ability to identify and control
emotions.

Development in relation to other
Role of an AWW
children
– Respect feelings and rights of other
Praise and encourage children
children by without hesitation

Listening to others and exchanging

Ensure that every child gets
ideas
attention.

Sharing and cooperating with
others
Try to highlight every child’s

Waiting for one’s turn strengths.
– Development of self confidence for
Give verbal acceptance to each
participating in group activities child’s feelings and encourage each

Development in relation to adults child to express his feelings.
– Listen to adults and follow
Provide opportunities for creative
instructions drama, role play, music & movement
– Control one’s own behaviour and creative activities.
– Cope with situation independently.

Be consistent in your approval and

Development in relation to disapproval of child’s behaviour.
environment
– Care of plants, animals and other
Treat all children alike. Do not
forms of life. compare, criticise, humiliate, hit, or
abuse children

Do not encourage differences in

expected behaviour and role of boys
and girls.

As far as possible be available &

accessible to children

68
 Activities for Psycho-social Development

1. Activities for Development in Relation to

Self

Developing familiarity with AWC
– Welcoming children with smile
– Introducing children to activities of
daily routine
– Taking children around AWC

Developing positive self concept
– Celebrating birthdays, doll’s marriage 2. Activities for Development in
– Preparing name cards for all children Relation to Other Children
– Displaying drawing/hand work of
Respecting feelings of other
children with their name on the board children
– Praising children on doing something – Free play - both outdoor and indoor
good in small groups
– Narrating an experience to develop
– Encouraging shy and quiet children.
habits of sharing and cooperating

Developing good personal habits through stories or puppet play or
– Washing hands before and after meals rhymes.
and after play, maintaining personal – Form a queue for hand washing or
cleanliness, eating properly going to toilet
– Using toilet properly
Developing self confidence for
– Not stealing or telling lies participating in group activities
– Putting garbage into dustbin – Encouraging children to perform
– Coming to AWC regularly and on time individually like tell a story or recite
a rhyme
– Putting things and all the play material
– Group games, songs & drama
back in place after its use.
– Celebration of Festivals, Birthdays,

Developing qualitites of initiative,
National Days, Organising bal
independance and leadership melas and picnic.
– Free play activities
– Encourage children to choose their
activities
– Asking children to distribute things/
toys by turn
– Assigning responsibility to children
like putting away material, getting
AWC in order
– Giving lead role to children by turns
in singing rhymes and playing games.

Psycho-social development activities have not been illustrated for the different
age groups as they are to a large extent applicable in more or less the same form
across the three age groups listed for other developments.

69
 Activities for Psycho-social Development

3. Activities for Development in

Relation to Adults

Developing abilities to relate well
with adults
– Following Instructions Activities
– Praise and reward for good behaviour
– Encourage children to talk
– Teach children to respect elders
through stories, drama & poems.

Developing ability to control one
one’ss
own behaviour and cope with
situations
– Guide and encourage children to Giving stars (*)/Rewards to children
play & learn for good work
– Take children out on trips and
excursions and let them be on their
own
– Story telling, Dramatisation and use
of incidental experiences.
4. Activities for Development in
Relation to Environment

– Developing sense of responsibility

towards elders, disabled and needy

– Structured conversation, Story telling

and Dramatisation for exposing
children to develop the concept of
care of old, disabled and needy

– Develop an attitude of care and

nurturance - gardening, planting
flowers, nature walk, care of pets,
leaving food for birds & animals,
keeping Anganwadi neat and clean
by picking up toys after play, picking
up bits of papers and putting in dust
bin, etc.

70
2.5.4 Activities for Creativity and Science Exposure

Objectives

Development of Creative Expression
through art

Development of Creative Movement

Development of Creative Thinking

Development of Aesthetic
Appreciation

Development of Concept related to
Science – air, water and plants etc.

Role of AWWs
 Encourage children to be spontaneous in their expression of feelings and ideas.
 Encourage children to explore, be curious and ask questions.
 Give children time and freedom to think and make choices by providing a balance of
free and structured play.
 Accept and appreciate individual differences in children.
 Take children out for nature walk and encourage them to observe and describe.
 Provide children with a variety of experiences which will form the basis for their
creativity and play material to use in many different ways.
 Appreciate every child’s effort, even if it can still do with a lot of improvement.
 Do not create an authoritarian climate with the children with a stress on structure,
rules and regulations.

71
 Activities for Creativity and Science Exposure

Activities for Creative Expression through Art

– Drawing & colouring, painting, printing, tearing, cutting and pasting-collage, clay
modelling, paper folding.
Activities for Creative Movement
– Action rhymes, finger play, rhythmic movement with dhapli and drum, creative drama,
story dramatisation and games like ‘dumb charade’.
Activities for Creative Thinking
– Free play, particularly dramatic or make believe play, constructive play, open-ended
question, creating a story and rhymes.
Activities for Development of Aesthetic Appreciation
– Decorating the AWC/classroom, displaying material, nature walk, appreciating
environment.
Activities for Development of Science Concepts
– Experiments with water – Water has no shape/water has no colour/water evaporates
– Experiments with air – Blow a balloon/Air blows away light objects
– Experiments with magnet
– Know the temperature – hot and cold
– Seed Germination
– Collection of different leaves and flowers.
– Name the parts of a plant

Science Activities

72
 Age Specific Activities for Science Exposure
Activity 3-4 Years 4-5 Years 5-6 Years

Growing plants Grows plants in Grows seeds and Germinate seeds

small pots/cups water them regularly using cotton

Blowing balloons Blows balloon Blows balloon Blows balloon and

observes release of air.

Properties of Water Can tell 2-3 uses of Can make a paper Can understand that
water boat and float it in water does not have
the water tub. any shape and takes
the shape of container.

Age Specific Activities for Creativity and Aesthetic Appreciation

Category Activity 3-4 Years 4-5 Years 5-6 Years
Creative Drawing Scribbles with Draws recognizable Draws many
Expression Colouring enjoyment figures and meaningful figures
through art Painting Draws circle meaningful drawings and shapes.
with crayons
Creative R h y t h m i c Moves as per Moves faster and Moves much
Movement Movement as per 1-2 variations on with 2-3 variations faster with 2-3
the beat by dhapli the beat in the beat variations at
Introduce a beat frequent intervals
by dhapli or drum
and ask the
children to move
on the beat. Keep
on making it faster
or slower as per
the age of children

Creative Open-ended Can give one or Can give 3-4 line Can answer in
Thinking Questions two lines answer answer to a detail e.g. How
Ask children to a question e.g. question e.g. what many ways can
simple questions what will you do will happen if you you use a bucket?
which stimulate on Diwali? get wings?
their imagination

Aesthetic Nature Walk – Enjoys Nature Enjoys Nature Enjoys Nature

Appreciation Develop Walks & admires Walks and Walks, admires &
sensitivity flowers, butter- admires & collects collects different
towards colour flies etc. flowers & leaves. types of leaves
and beauty in the and flowers.
environment
during Nature
Walk.
73
2.5.5 Nature Walk

Nature Walk refers to taking children on an outing in a park, garden etc. to observe
natural phenomenon.

Nature walk is an excellent activity for stimulating language through first hand
observation of natural phenomena, for example, changes due to seasons, plant growth,
the physical environment, activity of birds and insects, etc.

Remember the following while planning a Nature Walk

– Prepare children before hand and tell them where they are going and what they
should observe.

– Try to give a specific assignment, for example, look out for and collect leaves/
twigs/dry leaves/fallen petals/ caterpillars etc.

– Give tiny baskets/plastic bags/small match boxes for collecting the material.

– Carry a magnifying glass and let them see leaves, ant hills, etc. through it, in small
groups.

– Encourage them to talk about what they are seeing around them.

– Let them bring back the collected things which can be used for sorting, matching,
classification, creative activities, etc.

74
2.6 Planning and Organising PSE Activities
at AWC

Organising PSE activities require systematic planning for full year, week and for every day
in advance.

PSE activities should be planned keeping in mind the age as well as the developmental
level of children.

While planning and organising PSE activities, remember to:
– Give importance to:
 Developmental needs of children
 Age and stage of development
 Balanced & integrated approach for holistic development
– Reflect a balance of:
 Individual and group activities
 Outdoor and indoor activities
 Active and quiet activities
 Free and structured activities
– Proceed from:
 Concrete to abstract
 Familiar to unfamiliar
 Simple to complex
– Follow the sequence of:
 Real life experiences
 Experiences through material that represent real life experiences
 Experiences through pictures of real life experiences and drawings of objects
 Working with symbolic material, like alphabets and words.
 Plan and organise PSE activities using playway approach

Tips for AWWs for Organising PSE Activities

Listen to what children say and respond to them

Encourage children to speak, express their feelings and ask questions.

Praise the efforts of all children and encourage them

Involve all children in the activities, especially give opportunities to the quieter children
to come forward.

Help children to develop proper attitude, behaviour and habits in the Anganwadi

Give simple and clear instructions, one at a time, to children for conducting the activities.

Remember to include PSE activities from all the themes of child development.

75
Playway Method for PSE Activities

Playway method is a way of providing child-centered, enjoyable and entertaining learning
experiences to children through play for their all round development.

Playway approach in organizing PSE activities help in -
– Providing balanced, process-oriented programmes which fulfil development needs.
– Creating environment to express ideas, explore & understand.
– Promoting creativity and aesthetic sense
– Making learning enjoyable
– Fulfilling the need to touch, catch, jump, feel etc. and coordinate through physical &
motor development activities
– Giving opportunities for understanding concepts and developing basic cognitive skills
– Fulfilling the need to learn, share, give & be with others
– Fostering curiosity, ability to ask questions, need to listen, sing, repeat words, etc.
– Building social relations
– Promoting language and communication ability
– Providing flexibility to accommodate immediate needs of children.

Playway activities can be organised as small group activities where children are divided
into small groups for doing guided and free play activities simultaneously.

Children can also be divided into groups according to the age so that AWW has to
guide only one group at a time.

In a preschool, playway activities should start from free play, which are to be followed
by structured play activities, constructional play activities and then creative play
activities.

Playway Activities
PSE activities based on Playway Methods are:

Free and structured conversation
Sand play

Story-telling and story-making
Water play

Dramatisation
Puppet play

Rhymes and songs
Circle/group games and activities

Music and movement
Structured cognitive and language

Free indoor play with puzzles, beads, activities with play material
blocks etc.
Nature walk

Outdoor play
Field trips/outings

76
What is Play?
Natural to Children
Play is
Enjoyable

Attractive

Rewarding

Participatory

Promote intellectual &

social skills

Types of Play

Free Play – children play on their own without any specific

instructions
Structured Play – children are directed to play in some guided
form i.e. with specific instructions.
Manipulated Play or – involves putting things together to make something.
Constructional Play
Creative Play – Using imagination, thought and judgement in
working with material and creating something new.

77
Theme Approach
Theme Approach can be used in planning activities, which means
giving a complete experience to the child based on a theme, within
the child’s range of experience & understanding.

Themes can be selected from the child’s immediate environment and interest like –
– Child’s relationship with physical environment
– Child’s relationship to self and people
– Child’s relationship with technology.
– Child’s relationship with current issues and events

Theme approach incorporates all areas of learning like outdoor games, picture reading,
concept formation, dance, drama, puppet play etc.

A theme can be carried out for a week or a fortnight based on ability to sustain interest
and plan activities.

Sample List of Themes

Physical Environment Relationship to Technology

Transport – road, water, air and rail
Plants Industries/factories/products
Flower Electrical gadgets
Trees Mass media
Vegetable TV/radio/computers
Fruits Telephone

Animals Self, Family and People

Domestic/Pets Myself
Wild Life Parts of the body
Birds Family
Insects Homes and Shelter
Festivals
Weather/Seasons/Nature Basic needs
Rain Food /Clothing
Clouds Milk & Milk Products
Sun Occupation
Sky Games
Moon
Stars Relationship to Current Issues
Water Health and hygiene
Air Diseases
Fire Safe surroundings
Safety habits
Conservation of water / trees / energy

78
2.7 Illustrative Plan for a Day for Preschool
Education Activities at an Anganwadi Centre

Activities Time

Welcome, Prayer and Checking 20 Minutes

Personal Hygiene

Free Conversation 10 Minutes

Cognitive Activities in small and large group 20 Minutes

Physical P.T/Outdoor Play 20 Minutes

Art & Craft/Clay Modelling/Sand/ 20 Minutes

Water games/ Drama/Dance/
Puppet Play /Doll Play /Science Activity

Language Activities in large group – Rhymes/ 20 Minutes

Action Songs/Alphabets and Numbers &
Picture/Chart Reading/Story telling

Pack up and Good bye

(Children are sent back after giving 10 Minutes
Supplementary Food)

Note:

Nature walk to be organised once in two months.

Visit to zoo, outings and celebration of birthdays & festivals as per the convenience.

79
2.8 Basic Minimum Kit of Play Material for
Preschool Education Programme

A Basic Minimum Kit for PSE activities is provided to AWCs by the State Government, the
details of which are given below:
Material in PSE Kit

1. Building Blocks 7. Body Part puzzle

2. Shape Tower 8. Flannel Board with Cut outs
3. Construction Toys 9. Dolls
4. Threading Boards 10. Kitchen set
5. Beads and Wires 11. Wheel toys
6. Arranging Tray 12. Dhapli

PSE Kit Material and Purpose Activities to be Conducted

1 . Building Blocks

Through fun and free play promote:
– Creative thinking
– Fine muscle coordination
– Social skills through group play
– Classification skills
– Problem solving skills
– Aesthetic development
– Concept formation

Children can be asked to separate the
blocks according to shapes, color, size
to enhance their classification skills.

Draw or trace a particular block.

Matching of blocks

Pairing identical block by touching/
feeling the shape in a bag.

Naming/learning names of the shapes
–circle/triangle, square, rectangle.

Running by balancing block on the
head.

2 . Shape Tower
Building a tower

For Promoting:
Touch, see and say
– Exploratory play
Make a road map
– Problem solving
Colour & shape matching
– Creativity
Weight game
– Development of concepts of colour,
Block and socket game
shape, size, weight, length etc.

3 . Construction Toys
Matching the blocks

· For Promoting:
Play Memory games
– Fine motor skills
Naming colour of the blocks.
– Creativity
– Self confidence
– Team spirits
– Eye hand coordination

80
 PSE Kit Material and Purpose
4 . Threading Boards

For Developing:
– Eye hand coordination
– Fine muscle coordination
– Imagination and creativity
– Self confidence
5 . Beads & Wires

For Developing:
– Fine muscle coordination
– Eye hand coordination
– Concentration
– Cognitive skills
– Social skills
6 . Arranging Tray/Fruit
Vegetable Board

For Promoting:
– Concept formation
– Cognitive skills
– Fine muscle coordination
7 . Body Parts Puzzle

Through fun and free play:
– Skills of exploration
– Creativity
– Language skills
– Concept formation
8 . Flannel Board with Cut Outs

For Developing:
– Language skills
– Creative thinking
– Imagination
– Awareness of things/objects
available in the environment
– Skills of working in a group
– Positive self concept
– Self confidence
Activities to be Conducted

Thread the board

Join the board by threading

Balancing board on head

Tracing on floor or paper

Sense of touch – can feel texture
(smooth/rough).

Guessing – No. of beads in each hand

Playing game with beads

Sorting out mixed beads

Threading the beads in a given pattern.
and
Match and fix fruits & vegetables in
shape slots provided on the board

Sorting fruits and vegetable separately

Name fruits and vegetables.

Complete the body by using the various
pieces

Arranging the pieces in different ways
to form different postures

Story telling

Picture reading/conversation

Making different pictures/stories

Matching and classification games

Finding a Partner (game)
81
 PSE Kit Material and Purpose Activities to be Conducted

9 . Dolls
Drama, role play

Providing opportunities for :
Seriate dolls according to height, clothes
– Emotional release and adjustment
Celebrating doll’s birthday, social
– Understanding of social roles and festivals etc.
relationships
– Creativity & imagination
– Textural sense

10.Kitchen Set
Celebration of doll’s birthday

For Promoting :
Role play – wedding celebration
– Creativity and imagination
Identification of utensils for cooking and
– Provides fun and free play serving

11.Wheel Toys
Push and pull games

For Developing :
Drawing using toys as models
– Gross and fine muscle coordination
Story telling and dramatisation
– Creativity
Show and Tell activity
– Language skills

12.Dhapli
Tap on the beats to create own rhythm

For Developing:
– Sense of rhythm

82
2.9 Anganwadi – A Centre for Joyful Learning
Goal Provide enjoyable, enriched and stimulating environment for holistic development of
children
Objectives
a) Ensure exciting, enjoyable & nurturing environment
b) Provide enriched learning experiences and opportunities to explore, experiment &
discover.
c) Give exposure to a variety of objects, places, toys and play facilities.
d) Provide opportunities for meaningful interaction with adults and children.
e) Generate warmth and emotional security and support
Approach Playway Approach
Minimum Requirements

Adequate space for group work, individual work & specific activities.

Good quality, durable and safe play material within children’s reach.

Useful and comfortable equipment and furniture for work area and both indoor and
outdoor activities.

Outdoor area to be organised for freeplay, structured games, physical exercises,
multimedia activities with water, sand and clay, bird’s house/animal corner etc. and
Toilet

Indoor space to be organised to provide space for children to sit in a semi circle & play.

Specific areas can be marked as:

i) Work Area – area where children can sit in groups and do puzzles, and writing
work. It should have a blackboard.
ii) Cooking Corner – Place for cooking and serving supplementary food, storage of
food, supplies and drinking water.
iii) Object Corner - With blocks, ball, toys, picture books & PSE Kit within children’s
reach. It should have cupboard for storage of PSE Kit & material.
iv) Paper Work Corner - with coloured papers of various shapes & colours and a
display board for putting the craft work done by children
v ) Art & Craft Corner – with slates, chalk, crayons, paint & paint brushes.
vi) Doll’s Corner – with dolls and their clothes, kitchen set, sofa set, puppets etc.
vii) Science Corner – with jars, bottles, spoons, salt, sugar etc. for simple science
experiments with water, air, seeds and plants.

Indoor area should also have an area marked ‘My Corner’. It should have a - Mirror on
the wall, Weighing Scale and Height Chart, and a set of Comb and Towel in a pouch for
each child with the name of the child written on it.
Resources for PSE

PSE material & equipment provided from CDPO’s Office.

Low cost play material prepared by AWW

Toys given by community

Material and equipment given by the community, Panchayat, Youth Club, etc.

83
An AWW & a Helper are responsible for setting up and managing an
Anganwadi Centre.

Layout of an Anganwadi

84
Nutrition and Health Care

85
86
 3 PART
Nutrition and Health Care
Page
3.1 Importance of Good Health & Nutrition 89

3.2 Nutrition and Health Services at AWC 91

3.3 Nutrition and Health Care of a Pregnant Woman 114

3.4 Care of a Newborn 121

3.5 Nutrition and Health Care of a Nursing Mother 123

3.6 Breastfeeding 125

3.7 Nutrition and Health Care of Infants and Children 128

(Below 6 Years)

3.8 Feeding Problems among Children 130

3.9 Nutrition and Health Care of Adolescent Girls 133

3.10 Common Childhood Illnesses and Deficiency 135

Diseases: Identification, Prevention and Treatment

3.11 Medicine Kit and Treatment of Common Childhood 169

Diseases and Ailments & First Aid for Injuries

3.12 Intergrated Management of Neonatal and 176

Childhood Illnesses (IMCI)

3.13 Personal Hygiene and Environmental Sanitation 180

87
 Functions of Food

Include some foods from each of the three groups in the daily diet

Physiological Psychological Social Functions

Functions Functions
– Provides energy – Satisfies emotional needs – Brings people together
by means of shairng
– Provides material for – Gives security
growth, tissue building, &
body repairs
– Gives protection from
diseases

88
3.1 Importance of Good Health & Nutrition

What is Health & Nutrition?

Health is defined as a state of complete physical, mental and social well-being and
not merely the absence of disease or infirmity

Nutrition is the process by which a human body ingests, digests, absorbs and utilizes
nutrients present in the food and disposes off the end products.

Good Nutrition is that quality of nutrition in which the essential nutrients are
utilized in correct amount to promote best of physical and mental health.

Nutrients are the constituents of food. Nutrients must be supplied to the body in
suitable amounts.

The six nutrients required by our body are
i) Carbohydrates ii) Proteins iii) Fats
iv) Vitamins v) Minerals vi) Water

Balanced Diet is a diet in which all the nutrients are present in the right amount as
required by the body.

Food & its Functions

Food is anything solid or liquid which when swallowed, digested and assimilated in
the body keeps it well.

Food is basic to our existence and is important for health and satisfactory growth at all
stages of life.

Food can be obtained from plant and animal sources.

Food is classified into three Food Groups according to the functions. These are:
1. Energy Giving Foods
2. Body Building Foods
3. Protective Foods

Food fulfills physiological, psychological and social needs of an individual.

Food Requirements vary according to age, sex, physical activity and

physiological condition of an individual

89
Nutrients and their Functions

Sources and Functions of Essential Nutrients

Nutrients Sources Functions

1. Carbohydrates Cereals, millets, roots and
Supply energy to the

tubers, such as potatoes, body.
sweet potatoes, yam,
tapioca, Colocasia (arbi),
sugar and jaggery

2. Proteins Fresh or dried milk, cheese,
Build and repair body

curd, oilseeds and nuts, tissues, muscles and vital
soyabean, yeast, pulses, fluids like blood
meat, liver, fish, egg, cereals,
Help in forming
defatted oilseeds flour and enzymes and antibodies
soya flour to fight infection.

3. Fats Butter, ghee, vegetable oils
Serve as a concentrated

and fat, oilseeds, nuts and source of energy and
soyabean. provide essential fatty
acids.

4. Vitamins & Minerals Fish liver oil, liver, milk and
Helps keeping the body
milk products (curds, butter, healthy by building up
ghee), yellow and red fruits, immunity against illnesses.
green leafy and yellow
vegetables (carrots, pumpkin)
and fortified fats.

Take plenty of clean water and roughage to regulate body processes

90
3.2 Nutrition and Health Services at AWC
3.2.1 Nutrition Services
Nutrition Services under ICDS Programme

Supplementary Nutrition
i) Supplementary Feeding
ii) Prophylaxis against vitamin A deficiency and Control of Nutritional Anaemia

Growth Monitoring

Nutrition and Health Education

3.2.1.1 Supplementary Nutrition

Supplementary Nutrition includes supplementary feeding and distribution of nutrition
supplements i.e. vitamin A and Iron and Folic Acid tablets to the beneficiaries.
i) Supplementary Feeding

At AWC, Supplementary Food is provided with an aim to meet the gap of nearly 1/3rd of
calories and protein requirements for a day of children below 6 years as well as of adolescent
girls, pregnant woman and nursing mothers.

Supplementary Food is provided for 300 days in a year which means six days per week or
25 days per month.

Supplementary Food, given to severely malnourished children is twice the quantity (double
ration) given to moderately malnourished children.

While distributing Supplementary Food, special attention is given to children below
3 years of age

Prevalent Norms of Supplementary Food

Nutritive Value of
Beneficiaries Supplementary Food
Calories Protein
Children (0-3 years) 300 10 gms.
Children (3-6 years) 300 10 gms.
Severely malnourished children
(6 months-72 months) 600 20 gms.
Pregnant Woman and Nursing Mothers/
Adolescent Girls (Under KSY) 500 20 gms.

91
 It has been desided to provide 50% of the recommended dietary
allowances (RDA) for different micronutrient to 6 years old children through
80g of ready-to-eat energy food/raw food material.
The mean RDA for children 6 months to 6 years and the 50% of RDA
are as under:

Micronutrients Average RDA 50% of RDA

Calcium (mg) 450 225
Iron (mg) 15 7.5
Iodine (ug) 100 50
Zinc (mg) 10 5
Vitamin A (ug) 400 200
Riboflavin (mg) 0.9 0.5
Ascorbic acid (mg) 40 20
Folic Acid (ug) 35 20
Vitamin B12 (ug) 0.2-1.0 0.5

92
Selection of Beneficiaries

An AWW has to identify eligible beneficiaries for Supplementary

Feeding which include children (6 months - 6 years), pregnant women
and nursing mothers.

a) Pregnant Women & Nursing Mothers

Pregnant women and nursing mothers are eligible
for Supplementary Feeding if they belong to:
i) Families of landless agricultural labourers
and marginal farmers (those holding land
not exceeding one hectare.)
ii) Scheduled Castes and Scheduled Tribes.
iii) Families which are targeted under IRDP.
iv) Families having a total monthly income
not exceeding Rs. 500/- per month.
v) Pregnant women or nursing mothers, who
are enlisted by ANM or the Medical
Officer on medical grounds.

Pregnant Women are eligible for
Supplementary Food from the day the
pregnancy is discovered upto the date of delivery.

Nursing mothers are eligible for Supplementary Food for the first six months of
lactation.
b) AWW/Helper
c) Adolescent Girls
d) Children in the age group 6 months to 6 years.

Children below six years who are malnourished.

All children attending Anganwadi for non-formal preschool education (generally in
the age group 3-6 years) irrespective of their nutritional status.

Children belonging to families identified
under nutritional services of Integrated Rural
Development Programme (IRDP).

Children aged 3-6 years who are physically
present at the time of distribution of
supplementary food at the anganwadi
irrespective of their nutritional status.

93
 Selection of Food for Supplementary Feeding

States/UTs are responsible for providing Supplementary Food with equal central assistance.

The type of food given (pre-processed or Ready-to-Eat food or food prepared on the spot
from locally available food) varies from State to State.

The type of food given depends upon the local availability, beneficiaries, location of the
project, administrative feasibility etc.

Food selected for Supplementary Feeding should include mixture of cereals (wheat, rice,
maize, jowar, bajra, ragi); pulses (soyabean, gram, channa, moong, arhar, masoor etc.);
green leafy vegetables and fruits, oil and oil seeds (groundnut, mustard, til, coconut or
soyabean); and sugar or jaggery.

CARE/WFP also provide food aid for Supplementary Nutrition in some States.

Cooking, Distribution & Serving of Storage of Food

Supplementary Food
Points to Remember

Develop a number of recipes, so that
there is a variety in the food given.

Work out the total quantity of food to
be cooked daily in advance so as to
avoid shortage or wastage.

Prepare food daily under hygienic
conditions, using clean water.

Wash hands with soap and water before
cooking and serving the food.

Wash utensils used for cooking and
serving food daily.

Cook food well in advance and keep
it covered to protect from dust and
flies.

Use a standard measure such as a cup
or a spoon to serve the food.

Ask the beneficiaries to eat the food
at AWC only.
Points to Remember

Have proper storage space to store food
material.

Store room and the container should be
cleaned thoroughly before storing the
food grains.

Store room should be well ventilated and
leakage of water should be checked.

Doors of the store room should be
skirted with tin sheets and the windows
fitted with strong nets to prevent the
rats from entering the store room.

Use rodent proof bags for storing the
grains.

While storing grains in sacks, dry them
and keep them on dry hay or wooden
platform or polythene sheet to prevent
dampness from the floor.

If metal bins are used for storing grains
make them air tight by inserting a
polythene in between the lid and the bin.

Do not mix fresh stock with old stock
and check periodically for any
infestation.

Clean and sundry grains after rainy
season.

Use neem leaves, haldi/salt/oil etc. to
prevent infestation and loss of moisture
in the stored food.

94
ii) Vitamin A and Iron and Folic Acid Supplements

Vitamin A Supplementation

At AWC children are administered vitamin A at periodic intervals according to their age to
prevent vitamin A deficiency.

Age Dose of Vitamin A

Children One dose of 100 000 IU of vitamin A orally

(6-11 months) (Measles immunization is a good time to give a
routine dose).
Children One dose of 200 000 IU of
(1-5 years) vitamin A orally every six months

Iron and Folic Acid Supplementation

All pregnant women and children (1-5 years) are given Iron and Folic Acid tablets to prevent
anaemia as per the following recommended dose irrespective of their haemoglobin status.

Beneficiary Dose Quantity

Pregnant Woman 1 Big Tablet 1 Tablet for 100 days

(each tablet containing (in 3rd semester of pregnancy)
100 mg. of elemental iron
and 0.5 mg. folic acid)
Children 1-5 years 1 Small Tablet
(each tablet containing 20 mg. 1 Tablet for 100 days
elemental iron and 0.1 mg. every year
folic acid)

95
3.2.1.2 Growth Monitoring
What is Growth Monitoring?

Growth Monitoring means keeping a regular track of the growth of the child through
key indicators like weight, height according to age etc. at regular intervals.

Growth Monitoring is a way to detect growth failure in children at an early stage and
take immediate and effective action

Growth Monitoring must start right from the birth of the child.

In ICDS, Growth Monitoring is done with the help of Growth Chart.

Growth Chart is a tool for assessing the growth of the child using ‘weight-for-age’ as indicator.
It is a visual record of the growth pattern of a child.

Growth Chart also determines the grades of malnutrition of a child, identifies beneficiaries
for Supplementary Feeding, and is used for imparting nutrition and health education to
mothers.

Four growth curves on the Growth Chart depict the growth of the child and help in assessing
his/her nutritional status

Growth chart has two axis:

– The horizontal axis is for recording the age of the child and is being referred as
‘month axis’.

– The vertical axis is for recording the weight of the child and is being referred as
weight axis
axis.

Weight of the child as per the age is plotted on the Growth Chart.

When should an AWW weigh the children?

– Weigh all children upto 3 years of age every month.

– Weigh children 3-6 years old every

three months.

– Severely malnourished children

and children who have not
gained weight consecutively
for three months should be
weighed every month (irrespective
of the age).

96
97
Steps in Weighting the Child

98
How to Monitor Growth of Children?
Steps in Growth Monitoring are:
1. Determine correct age of child
2. Determine correct weight of child
3. Plot weight accurately on the Growth Chart
4. Interpret the direction of the Growth Curve and recognize growth failure, if any
5. Discuss child’s growth with mother and the Follow-up

Step 1
Determine the correct age of the child

Knowing the correct age of the child is necessary for accurate growth monitoring.

Assess the child’s age by:
– Asking mother /older members of the family.
– Checking birth register/home visit register/hospital records for the age of the
child
– Using local events calendar while talking to the mother about child’s age. A local
events calendar indicates all the dates on which important events took place
during the past five years like names of months, important events in the agricultural
season of the area, local festivals, national festivals, phases of moon etc.

Step 2
Determine correct weight of the child

AWWs are provided Salter/Bar weighing scale for taking the weight of a child.
Steps involved in weighing the child are:
a) Setting the Scale
– Hang the scale securely from a beam or branch of a tree
– Keep the dial at eye level so that the weight can be easily read.
– Place the cradle or infant sling on the cradle hook.
– Adjust the pointer to zero by turning the screw on the top of the scale
b) Weighing the Infant or Child
– Ask the mother to remove child’s heavy clothing
– Place the child in the cradle
– Child’s feet should not touch the ground.
c) Reading the Scale
– Scale is graduated from 0 to 25 kg. Each Kilogram is divided by a
500 gm or a 100 gm. marking. Read the Pointer on the scale to
nearest 100 gms.
– Ask the mother to stand near the child and talk to him/her so that he/she does not cry.
– Read the weight while standing exactly opposite the scale. Do not read the scale
from the side.

99
 Step 3
Plot weight accurately on Growth Chart

Plotting the weight on the growth chart reveals whether the child is growing normally or
not.

Growth Chart should be filled-up systematically as given below:
a) Fill up all the necessary information about the child in the Index box on the Growth
Chart Register.
b) Fill up the information box on the Growth Chart which
gives the child’s name, father’s name, mother’s name
and family registration number.
c) On the ‘month axis’, in the first box write the name of
month and year during which the child was born and
then fill up the remaining months and year columns for
all the five years.
d) On the ‘month axis’ identify the ‘month box’ which indicates the present age of the
child.
e) Write the weight taken below the ‘month box’.
f) On the ‘weight axis’, identify the line which indicates the present weight of the child.
g) Plot the weight in the appropriate square above the identified ‘month box’.
h) Draw a circle around the dot so as to know its position.
i) Now connect this dot with the dot made on the previous month with a line. This forms
the growth curve.

Step 4
Interpret the direction of Growth Curve

Direction of Growth Curve of the child can be upward, flat or downward.

Direction of Growth Curve is more important than the actual
weight of the child at any point. It can be interpreted as: r
8
d F l a t
7
Growth D
ow
a nw
w
– Upward Growth Curve indicates that the child is gaining p
U ro w
th
6
5
ar
d
Gr
G ow
weight and is growing. 4
3
th

– Flat Growth Curve indicates that the child is not growing 2

1

adequately. 0
May-99
Mar-99

Oct-99
Apr-99

Aug-99

Nov-99
Feb-99
Jan-99

Jun-99
Dec-98

Jul-99

Sep-99

– Downward Growth Curve indicates that the child is in danger

and needs immediate health care.

Weight of all normal healthy children fall above the top curve.

A child is malnourished when weight falls below the top curve which can be graded
as given below (as per IAP classifications):
Grade I (Mild Malnutrition) – Weight of the child between 1st & 2nd curve
Grade II (Moderate Malnutrition) – Weight of the child between 2nd and 3rd curve
Grade III (Severe Malnutrition) – Weight of the child between 3rd and 4th curve
Grade IV (Severe Malnutrition) – Weight of the child below fourth curve

Corrective action on the first sign of growth faltering can help in restoring health.

100
S.No. Curve Status Role of AWW
1. Above first curve Normal Nutrition and Health Education and
counseling to the mothers
2. Between first and second Grade I Nutrition & Health Education and
growth curve counseling to the mother
3. Between second and Grade II
Supplementary Nutrition at AWC
third growth curve
Nutrition and Health Education and
counseling to mother
4. Between third and fourth Grade III
Supplementary Nutrition (double) at
growth curve AWC

Refer to PHC/Hospitals

Nutrition & Health Education and
counseling to mother.
5. Below the fourth growth Grade IV
Supplementary Nutrition (double) at
curve AWC

Refer to PHC/Hospitals

Nutrition & Health Education and
counseling to mother.

Step 5
Discuss Child’s Growth with Mother and Follow Up

Priortise children who are malnourished and whose mothers need counseling

Show the Growth Chart to the mother and explain the direction of the growth curve.

Discuss and ask the parents the reasons for no or poor weight gain.

Advise parents about nutrition care, frequency of feeding and blending with family
food patterns.

Monitor the growth of malnourished child regularly.

Convince mothers to bring the children regularly to AWC for weighing

Refer the children whose growth is faltering consecutively for 2-3 months or who
are severely malnourished to PHC Hospital.

101
3.2.2 Health Services

An AWW has to ensure that Health Check-up of all the beneficiaries

is done by health staff i.e. ANM/LHVs/Medical Officer.

3.2.2.1 Health Check-up

Health check up includes:
a) Antenatal check-up of pregnant woman
b) Post-natal check-up of nursing mother
c) Health check-up of children under six years of
age.

Health Services under ICDS

Programme:
– Health check up
– Immunization
– Referral Services

A. Ante-natal Check up

An AWW must ensure that a pregnant woman :
– Gets three antenatal check-ups done during pregnancy. During the check-up complete
physical examination of the pregnant woman should be done.
– Takes Tetanus Toxoid immunisation
– Takes IFA Supplementation (One IFA tablet for 100
days)
– Takes Supplementary Food at AWC
– Has her delivery conducted by trained dai or in
the hospital
– Has complete information on prenatal, natal and
post natal care.

An AWW should provide information to pregnant
women on care, diet & rest during pregnancy and
care of new born.

An AWW should keep a record of ante-natal care in
the ‘Mother Child Card’ provided for the purpose.

An AWW should identify ‘at risk’ pregnant women and refer them to the nearest health
facility

102
B. Postnatal Check up

An AWW may
– Ensure that atleast two visits are paid to
nursing mother by Health Staff within
first 10 days of delivery for observing
the condition of cord and general
health of the mother.
– Weigh the baby as soon as possible
after birth and record the weight on
growth chart.
– Check whether the baby is ‘at risk’ or
not, If yes, inform ANM/LHV/Medical
Officer.
– Ensure that breastfeeding is well
established.
– Ensure that the child is given BCG
immunization at birth and other Immunization according to the schedule after
6 weeks.
– Update the individual family record.
– Motivate the mother to adopt suitable family planning methods.
– Ensure that the nursing mother is registered for supplementary nutrition provided at
AWC.

C. Health Check-up of Children under Six Years

An AWW should
– Get the health checkup of children done quarterly by the
health staff.
– Keep a watch over child’s development as per the
milestones and monitor their growth.
– Give special care to children ‘at risk’ and monitor their
growth regularly.
– Ensure that all children are immunized and are given
vitamin A dose as per the Immunisation Schedule (See
page).
– Maintain record of health check-up of children.

103
 Pregnant Woman ‘At
At Risk
Risk’

Women who are under weight at the beginning of pregnancy (weight of 40 kg or less
prior to pregnancy).

Women who have height less than 5 feet

Women who gain too little weight during pregnancy

Women who have a very short period between one pregnancy and the beginning of
the next pregnancy

Women who have had still birth or abortion during previous pregnancies

Previous delivery of child who died within a month of birth

Women who become pregnant before the age of 18 years or after 35 years

Women who have more than 4 children

Women who have previously given birth to low birth weight babies

Twins

History of previous caesarean or instrumental (forceps) delivery

Prolonged pregnancy (14 days after expected date of delivery)

Children ‘At
At Risk
Risk’

Infants with low birth weight (less than 2.5 kg.)

When breastfeeding has not been established or is insufficient from the very beginning
of infant’s life

Inadequate or no weight gain for three consecutive months

Weight below 70% of expected weight (Grade II malnutrition)

Children having repeated infections especially diarrhoea

Birth order of five or more

The only child born after a long married life

One parent

History of death of more than two siblings during the first two years of life

Illness of parents

Alcoholic parents

Twins

104
3.2.2.2 Immunization

Immunization is a process by which a child is protected against diseases through vaccines.

Immunization protects children against six killer diseases i.e. Tuberculosis, Diphtheria,
Whooping Cough, Tetanus, Poliomyelitis and Measles

A child should be fully immunized against these diseases otherwise he/she may suffer
from illnesses, become permanent disabled or become undernourished or may die.

During pregnancy woman is immunized with Tetanus Toxoid (TT) to protect against
Tetanus.

Every child must be fully immunized as per the Immunisation Schedule for complete
protection against these diseases.

In ICDS, ‘a fixed day’ strategy is adopted to immunize children.

It is safe to immunize the child who has a minor illness, disability or who is malnourished.

Under Pulse Polio Programme, additional dose of OPV is given to all the children below
five years.

Immunization facilities are available at the AWC/Sub Centre/Primary Health Centre
free of cost.

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105
 Symptoms, Consequences & Prevention of Vaccine Preventable
Diseases
Disease Symptoms Consequences Prevention
Tuberculosis
Low grade fever
Child becomes
Give the child one
(Childhood) for a number of weak and dose of BCG
days, loss of malnourished vaccination at
weight, persistent
Lungs & brain get birth in the left
cough and affected shoulder
wheezing.

Child can become

Does not respond
hunchbacked
to antibiotic
therapy for ARI
In few cases
disease may be
fatal.
Points to Remember
Refer the child with above symptoms to hospital immediately.

After 4-6 weeks of giving BCG vaccination, a ‘pimple’ develops
which heals in 10-12 weeks leaving a small scar.

Poliomyelitis
Child has fever
Paralysis of one of
Child should be

with headache, the limbs. immunized with
sudden onset of 3 doses of Oral
weakness and
Lameness in Polio Vaccine at
pain in the children. an interval of one
muscles month starting

Crippling of any
from the age of

Paralysis of part of the body 11/2 months.
generally one leg
or arm or trunk.
Children below 5

In rare cases, it
may lead to years may be given
paralysis of extra doses of OPV
muscles of lungs under Pulse Polio
and throat and Programme.
lead eventually to
death.
Booster dose of
OPV may be given
between 18-24
months.

Points to Remember
Refer the child with above symptoms to hospital immediately

Oral Polio drops are given along with DPT vaccine

106
 Disease Symptoms Consequences Prevention

Diphtheria
Sore throat (with or
It may spread to
Child should be

without difficulty the windpipe and immunized with
in swallowing), choke windpipe 3 doses of DPT
mild fever, looks ill of the child Vaccine at an
and has no
Toxins can affect interval of one
appetite the heart muscles month starting

Neck is swollen and nerves from the age of
11/2 months.

Greyish or whitish
Has high rate of

Booster dose may
membrane in the fatality
throat be given between
18-24 months.

Points to Remember
Refer the child with above symptoms to hospital immediately.

DPT vaccine is given intramuscularly on the outer side of the
thigh. It is painful for a day or so which can be relieved with
Paracetamol

Pertussis (Whooping
Slight fever,
Causes
Immunize the

Cough running nose, malnutrition and child with three
cold & cough secondary doses of DPT

Cough gets infections like given at an
worse, child gets pneumonia interval of one
fits of cough and
May lead to month each
struggles for brain damage starting from the
breath. age of 1 1/ 2
months.

The breath is a

Booster dose may
noisy whoop.
be given between

During cough 18-24 months.
spasms, eyes may
bulge and bleed,
and child often
vomits

Points to Remember
Refer the child with above symptoms to hospital immediately.

107
 Disease Symptoms Consequences Prevention
Tetanus
Normal sucking
Gets into body
Pregnant women
and crying for the through cuts and should be
first two days of kill the infected immunized with
life. child. two doses of
tetanus toxoid

Child is unable to
Survival rate is vaccine.
suck between 3rd very very low.
to 28th days.
Child should be
given 3 doses of

Gets stiffness and DPT at an interval
convulsions of the of one month
facial, neck and starting from 11/2
waist muscles. months of age.

Child is unable to
Booster dose may
open mouth fully. be given between
18-24 months.

Body bends like a
bow due to
contractions of
neck and waist
muscles.

Points to Remember
Refer the child with above symptoms to hospital immediately.

Measles
Begins with fever,
Makes the child
Child should be

running nose and weak and vaccinated
cough susceptible to between 9-12

Eyes become red secondary months.
and watery infections of
Only one dose
lungs, ears, eyes is required.

Rash appears on & gastrointestinal
the face between tract.
3rd and 7th day.

In some cases it

Rash spreads over can be fatal due
the whole body. to complications.

Points to Remember
Refer the child with above symptoms to hospital immediately.

108
Immunization Schedule
Children
Vaccines 1 1/ 2month 2 1/ 2month 3 1/ 2month 9 1/ 2month 16-24 month 5 years
BCG (At birth)
DPT HBV Ist Injection 2nd injection 3rd injection Booster injection
OPV
(Polio drops) 1st dose 2nd dose 3rd dose Booster dose
Measles One
DT One

Pregnant Women
Tetanus Toxoid Time
1 Dose As early as possible
2 Dose One month after the first dose
Booster Dose One Booster dose in subsequent pregnancy, if
TT Vaccine has been taken within last 3 years

Points to Remember

A child should be immunized at the right time as per the above schedule.

If there is a gap of 4-5 months between two doses of DPT and Polio, the remaining
doses should be given to the child. In case it is further delayed he/she should be
immunized for all the vaccines again

109
3.2.2.3 Referral Services

An AWW should refer children and women who need immediate

medical care to PHC/Hospital using a prescribed Referral Slip

Referral Services include providing immediate medical care according to the seriousness
of disease as well as follow-up care of treated cases.

Pregnant women and children requiring specialised medical treatment are referred by
AWW/ANM/LHV to PHC/hospital.

AWW has to fill the Referral Slip while referring the patients to PHC/Hospital.

The Referral Slip has three parts. One part out of the three foiled parts of Referral Slip is
to be retained at the Anganwadi Centre; the second part is for the parents; and the third
part is to be given to PHC doctor by the patient. It is to be returned to AWW after the
patient comes back for ‘follow up action’.

The local bodies or panchayats may be involved to provide transportation for referral
cases, in case it is not available or family is unable to bear the cost.

When to Refer the Child to PHC/Hospital?

– A child with severe diarrhoea
– A child with rapid breathing rate (more than 50 per minute)
– Very low birth weight/premature delivery
– Patient with high fever for more than 4 hours inspite of treatment
– Fever with fits/convulsions
– A lethargic or unconscious child
– A child with malaria not responding to treatment
– A child having whooping cough with fever and loss of weight inspite of treatment
– A child who fails to gain weight for three successive months
– A severely malnourished child (Grade III & IV)
– A child who is unable to drink or/and refuses to eat
– A woman with high risk pregnancy/complications such as swelling of feet, high blood
pressure etc.
– A child with congenital defects/disability

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 Referral Slip Referral Slip Referral Slip

Integrated Child Development Integrated Child Development Integrated Child Development

Services Programme Services Programme Services Programme

(For AWW) (For the Parent of the Child) (For the Doctor)

S. No. __________ Date _________________ S. No. __________ Date _________________ S. No. __________ Date _________________

Village _________ AWC No. _____________ Village _________ AWC No. _____________ Village _________ AWC No. _____________

Name of the Child ______________________ Name of the Child ______________________ Name of the Child ______________________

Age _______________ Sex _______________ Age _______________ Sex _______________ Age _______________ Sex _______________

Year/Months ________ Male _______ Female Year/Months ________ Male _______ Female Year/Months ________ Male _______ Female
111

S. No. of Family ________________________ S. No. of Family ________________________ S. No. of Family ________________________

Signs of Illness _________________________ Signs of Illness _________________________ Signs of Illness _________________________

Illness _________________________________ Illness _________________________________ Diagnosis______________________________

Treatment Given _______________________ Treatment Given _______________________ Prescription ____________________________

______________________________________ ______________________________________ ______________________________________

Referred to _____________________________ Referred to _____________________________ Folow up ______________________________

Signature of AWW ______________________ Signature of AWW ______________________ Signature of Doctor ______________________

Name of AWW _________________________ Name of AWW _________________________ Name of Doctor ________________________

3.2.2.4 Nutrition and Health Education

Nutrition and Health Education (NHE) is provided with an aim to enhance the capacity
of mothers and community to look after the health and nutritional needs of children
within the family environment.

NHE helps in promoting antenatal care, maternal and child health, child survival and
development.

A special follow up is made of mothers whose children suffer from malnutrition or frequent
illnesses. Sustained support and guidance is provided to mothers of young children,
keeping in view their knowledge, attitude and local practices.

NHE messages can be imparted by using different methods which include:
– Use of mass media and other forms of publicity
– Organising special campaigns at suitable intervals
– Organising Mother’s meeting/Home visits by AWW
– Demonstration of cooking different low cost recipes and short courses for women
and adolescent girls by mobile vans of Community Food & Nutrition Extension Units
(CFNEUs).
– Utilisation of NHE programmes of other Government Departments i.e. Ministry of
Health & Family Welfare, Agriculture, Rural Development etc.

An AWW should use fixed day immunization session, mother-child

day, growth monitoring day, small group meetings of mothers/mahila
mandals/ community, home visits, and other such forums for
imparting NHE.

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 Role of AWW in Delivery of Nutrition and Health Services

Nutrition

Procurement of Supplementary Nutrition from CDPO’s office.

Selection of beneficiaries.

Planning and distribution of Supplementary Nutrition.

Maintaining cleanliness in cooking and distribution of food.

Storage of food.

Eliciting community participation in planning and organizing Supplementary Nutrition.
– Providing food material, fuel and transport for carting.
– Contributing seasonal locally available green leafy vegetables
– Helping in cooking and distribution of food.
– Helping in monitoring the nutrition provided at AWC.
Health

Ascertain the dates of visits of health functionaries to AWC.

Identification of children, pregnant women and nursing mothers who require special
care.

Ensure that every child receives immunisation & health check-up.

Prepare a list of children (below 6 years) and pregnant women who are to be
immunized.

Assist health staff in making all the arrangements for immunization i.e. sterilizing
the equipment, providing table, chairs at the AWC.

Collect all children and women at AWC on the scheduled day and time for health
check-up.

Ensure proper utilisation of health services by the community.

Keep a record of date and number of iron and folic acid tablets given to pregnant
women; date of TT injections taken; and nutrition & health education sessions
taken and topics covered

Keep a record of children referred to PHCs.

May accompany very sick patient to health facility centre

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3.3 Nutrition & Health Care of a Pregnant Woman
3.3.1 Pregnancy – A Period of Stress
A pregnant woman and the family members should know that:

Pregnancy is a period of great physiological as well as psychological stress for a woman.

During pregnancy, the baby in the mother’s womb grows from a minute cell to a fully
formed baby.

During pregnancy many changes take place in the mother’s body and she needs special
care.

During pregnancy, a woman should always remain happy and should maintain good
health so as to provide good nutrition for the development of foetus and prepare herself
for delivery and lactation.

risk factors
All family members and pregnant woman should know about the ‘risk factors’ and
alarming signs
‘alarming signs’ before pregnancy and take special care.

danger signs
On observing any of the ‘danger signs’, the pregnant woman should be referred to
hospital immediately.

A Pregnant woman needs special care during pregnancy

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 Danger Signs during Pregnancy

Warning Signs during Pregnancy

Failure to gain weight.

Anaemia - very tired or easily out of breath.

Unusual swelling on legs, arms or face.

Foetus moves very little or no movement

Danger Signs during Pregnancy

Bleeding during pregnancy

High fever during pregnancy

Anaemia

Continuous vomiting

Excessive weight gain

(more than 2 Kg in one month)

Convulsions or fits or
blurring of vision

Labour pain for more

than 12 hours

Bursting of water bag

without labour pains

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3.3.2 Nutritional Care during
Pregnancy
3.3.2.1 Registration
A pregnant woman on knowing her
pregnancy or within the first three months
of the pregnancy, must Register herself with
an ANM/AWW. A pregnant woman should
take ‘Mother Child Card’ Jachha-Bachha
Card from ANM/AWW.
An AWW should maintain record of pregnant women in the register
and on the Card

3.3.2.2 Nutritional Care

Eat balanced diet and variety of foods, so
that all nutritional needs are fulfilled.

Eat four to five times a day

Increase intake of cereals, pulses, milk and
milk products, and green leafy vegetables

Consume meat, fish and egg, if culturally
accepted and are affordable.

Include oil or ghee in the diet as these
are concentrated source of energy.

Consume iodised salt

Drink plenty of water.

Consume small amounts of food at short
intervals if suffering from nausea and
vomiting but should not stop eating.

No food should be avoided during
pregnancy but excessive intake of
caffeine, tobacco and alcohol should be
discouraged.

Supplementary Food
Consume ‘Supplementary Food’
provided at AWC daily and regularly.

Ignore harmful beliefs and practices
concerning food.

A pregnant woman should eat extra food i.e. 1/4th more than the
normal diet as she has to look after the needs of two lives – her own
and that of the growing baby.

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3.3.2.3 Health Care
Antenatal Care helps to:

Detect “high risk” cases and give them special attention.

Know the status of development of the foetus in the womb

Foresee complications and prevent them

Improve the chances of giving birth to a healthy baby

Reduce maternal and infant morbidity and mortality

Teach the mother elements of child care, nutrition, personal hygiene, and environmental
sanitation.
3.3.2.4 A pregnant woman must get a minimum of three health check-ups
done.

First Trimester - Immediately on knowing pregnancy (Before 3 months)

Second Trimester (Between 4-6 months)

Third Trimester (Between 7-9 months)

Incase there is any problem during pregnancy more frequent check-ups may be got done.

3.3.2.5 Weight Gain during Pregnancy

Weight Gain during Pregnancy

A pregnant woman should gain 10-12 kgs.
weight during pregnancy

The Gain in weight should be at least 1 kg
every month during the last 6 months of
pregnancy

Poor gain in weight during pregnancy
(5-6 kilograms) can lead to low birth
weight babies.

For adequate weight gain during
pregnancy, nutritious and adequate food,
care and more rest during the day is
required.

3.3.2.6 A pregnant woman must take IFA

Supplementation – one tablet of Iron and Folic acid
containing 100 mg. elemental Iron and 0.5 mg. of folic
acid daily for 100 days in the third trimester to prevent
anaemia.

Children born to iron deficient anaemic mothers are
found to have greater risk of being anaemic by their
first birthday.

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 Antenatal Care

– Health Checkup
Physical Examination

Weight Inadequate weight gain may lead to low birth weight babies
Blood Pressure High blood pressure can be fatal for both mother and infant
Abdominal Examination For increase in the size of baby and monitoring heart beat

Laboratory Examination

Urine Examination To minimize the risk of toxemia during pregnancy

Blood Test To check haemoglobin level for detection of anaemia
– Nutrition Iron and folic acid supplementation for prevention of
Supplementation anaemia
– Immunization For prevention against tetanus
– Nutrition & Health To take care of herself and the baby
Education
– Referral Services Refer to Hospital in case of Danger Signs

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 3.3.2.7 A pregnant woman should get herself
immunized against Tetanus Toxoid (TT) as
per the schedule (on Page 98)

3.3.2.8 An AWW should provide Nutrition

and Health Education to pregnant women
so that they can look after their own health
and nutritional needs as well as that of the
baby.

3.3.2.9 Rest during Pregnancy

A pregnant woman should take rest for at
least two hours during the day. It helps the
baby to grow well and improve his/her
birth weight.

While resting, she should lie on the left

side of the body

Routine activities should be continued

with short periods of rest in between.

She should not undertake physical

activities such as fetching water and
firewood, lifting heavy things, etc.

Family members should help the

pregnant woman in household chores so
that she gets time to take adequate rest.

119
3.3.3 Preparation for Delivery

A pregnant woman and her family must make necessary preparations for a safe delivery.

Delivery in a nearby Health Facility should be preferred as it is safe. If delivery is to be

conducted at home, it should be conducted by a Trained DaiDai/ANM. She should obtain
a Disposal Delivery Kit (DDK) from Govt. Hospital/Health Centre.

Necessary preparations for safe and clean delivery at home includes “Five Cleans” to
prevent infection. These are:

1. Clean hands
2. Clean surface – clean room and clean sheet
3. Clean blade
4. Clean cord tie (thread)
5. Clean cord stump

In order to meet emergency needs, money may be saved and arrangements for
transportation may be made in advance.

DDK

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3.4 Care of a Newborn

Newborn babies need special care and attention

Newborn care helps the baby to:
– Adjust to the new environment
– Establish cardio-respiratory function
– Maintain body temperature
– Avoid infections
– Promote establishment of lactation
– Helps in early detection and treatment of congenital disorders

Newborn care starts soon after the baby has been delivered as risk of death is greatest
during the first 24-48 hours

Newborn Care – Do’s & Dont’s

Check the following after the baby is born
– The cord should not be coiled around the baby’s neck. This can damage the brain
of the baby. If it is coiled, uncoil quickly and carefully
– Baby should cry immediately after birth
– Colour of the baby should be pink and not blue
– If pinched, the baby should move arms and legs.

Do not give bath to newborn baby. Wipe the baby and wrap.

Keep the newborn baby warm.

Do not apply anything on the cord.

Initiate breastfeeding within half an hour of birth. Do not give any other liquid.

Weigh the baby within 24 hours. If the birth weight is less than 2.5 kg, the baby is of
low birth weight and needs special care and extra warmth.

Ensure visit and check up of newborn by ANM within 7 days of birth.

Newborn baby should be kept close to mother to develop emotional bonding.

121
3.4.1 Care of Low Birth Weight Babies

If a baby is less than 2.5 kg, he/she is low birth weight baby and needs special care.

Provide extra warmth by wrapping the baby well and covering his head to prevent
heat loss.

Keep the baby close to the mother and she should breastfeed him/her frequently.

Too many people should not be allowed to handle the baby.

People who have infection should be kept away from the baby at least during the
first month.

Danger Signs among Newborns

Newborn baby is at risk if any of the following danger sign is observed. He/she should
be immediately referred to the nearest hospital

 Baby does not suck or refuses to breastfeed

 Baby does not cry/difficulty in breathing

 Baby is cold or hot to touch

 Baby develops yellowness in palm and soles

 Baby has convulsions

 Baby is drowsy or cries continuously

 Baby does not pass stool within 24 hours or urine within 48 hours

 Baby has any birth defect.

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3.5 Nutrition and Health Care of a Nursing Mother

Lactation

Lactation imposes greater strain on the mother than pregnancy, as

she nourishes a fully developed and rapidly growing baby.

A nursing mother needs special care

about her health, diet and factors
influencing lactation in order to
breastfeed her baby successfully.

A nursing mother should have the
confidence and desire to breastfeed her
baby successfully.

A nursing mother should breastfeed in
an absolutely relaxed state of mind, so
as to enable good flow of milk.

Nutritional Care

A nursing mother in addition to normal diet needs one additional good quality meal
every day

A nursing mother should continue to take sufficient amount of nourishing and

wholesome food to meet her nutritional requirements and to have sufficient milk for
her baby.

A nursing mother needs more proteins (high quality) for milk production. She should
have more of whole grain cereals, pulses/dals, milk, curd, green leafy vegetables and
fruits. Also, only iodized salt should be used.

A nursing mother should drink plenty of fluids.

A nursing mother should not eat spicy and high calorie food such as ghee, nuts, etc.
in excessive amount so as to avoid undesirable gain in weight.

If a nursing mother does not consume required amount of nutritious diet, her own
body stores will be used up for production of milk, thus affecting her health.

Food beliefs and practices which have no scientific basis should be discouraged.

A nursing mother should consume the supplementary food provided at the Anganwadi
Centre for six months after delivery to meet the increased nutritional requirements of
breastfeeding.

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 Health Care

The mother and the baby should have two health check-ups within 7-10 days of
delivery for their well being to prevent infection and to establish successful
breastfeeding.

A nursing mother and the baby should also have regular health check-up at
AWC/PHC.

For the mother, personal hygiene is very important, because any maternal
infection can easily be passed on to the infant.

A nursing mother should take bath daily and should take care to keep her breasts
clean and wear clean clothes.

After delivery, use of sanitary pads or clean cloth (sun dried) should be
encouraged.

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3.6 Breastfeeding

Breastfeeding is an optimal way to feed an infant and to improve his/her quality of life.

Breast milk contains most of the nutrients required for the growth and development of the
baby in the right proportion.

Advantages of Breastfeeding
Breastfeeding is advantageous to both baby and the mother

For Baby For Mother

Complete food for the baby for first six

months

Breast milk is safe and hygienic

Protects against infections / allergies

Easily digestible and absorbed

Higher intelligence quotient

Promotes emotional bonding
development
Helps delay in a new/another pregnancy

Protects mother’s health

Prevents anaemia and breast & ovarian
cancers in mothers

Helps in contraction of the womb
&

Almost all mothers can breastfeed successfully.

Frequent breastfeeding causes more milk to be
produced.

Breastfeeding at night is particularly helpful as

milk producing hormone is secreted more
during night and it provides relaxing effect to
the mother

Baby should be fed on demand (as and when

the baby wants) from both breasts many times
a day (8-10 times).

Prelacteal feeds such as sugar, water, honey,

ghutti etc. must be avoided as they interfere
with breastfeeding and reduce baby’s desire for
feed.

Breastmilk is a natural and a complete food for the baby for first six
months. During this period no other food or drink or even water is
required.

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 Colostrum Feeding

Mother must initiate breastfeeding within half or one hour of birth as babies are most
active during first 30-60 minutes and suckling reflex is most active at birth. This increases
success of lactation.

During first two/three days after the birth, the breasts yield a thick yellowish fluid called
colostrum which is the perfect food for new born babies and is rich in proteins, Vitamin
A and other nutrients. It has anti-infective factors, which provide protection against
infection and is considered the first immunization of the baby.

Early initiation of breastfeeding ensures intake of colostrum, which satisfies the hunger
of the baby.

The amount of colostrum available at each feed is small but it is sufficient for the
child and the baby needs no other food.

The act of suckling stimulates milk production and mother’s milk supply increases
slowly.

Correct Position of Mother and Child during Breastfeeding

While breastfeeding, mother should hold the baby in correct position as it ensures
adequate supply of breastmilk and reduces incidence of breast problems.

Mother should hold her baby comfortably during feeding

Position for Feeding Signs for Correct Sucking Position

Baby’s head and neck is straight or bent
slightly back.

Baby’s body is turned towards the
mother

Baby’s body is close to the mother
facing breast

Baby’s whole body is supported

Baby has eye-to-eye contact with
mother.

Baby’s chin touches the breast

Baby’s mouth is wide open

Baby’s lower lip is turned outward

Much of the upper dark part around the
nipple (areola) is seen inside baby’s
mouth

There is no pain in the nipple area
during breastfeeding

Incorrect sucking position may cause difficulties such as sore and cracked nipples,
inadequate milk and refusal to feed.

126
 Problems of Bottle Feeding
Mother should avoid using bottle at any
age as bottle feeding could be harmful
and can make the child refuse
breastfeeding.

Baby foods are expensive. The mother
over dilutes the baby foods which lead
to malnutrition

If bottle feed is not prepared
hygienically or the feeding bottles and
teats are not cleaned properly and
sterilized by boiling, chances of getting
infection to the child are more.

If the child does not finish the bottle
feed and the milk remains in the bottle
until the next feed, the milk can get
spoilt and cause infection, if fed.

The teat is often left uncovered and
exposed to flies and dust leading to
infection
Dangers of Artificial Feeding
Mother should not give artificial milk or
powdered milk to babies below six
months as infant formula is not as good
or complete as breastmilk.

Artificial feeding includes infant formula
(powdered milk), animal milk (cow,
buffalo, goat, camel milk) and
condensed milk

Mothers using artificial milk face
difficulties in rearing the baby because
artificial feeds/formulas:
– do not contain appropriate amount
of proteins, fats, vitamins and
minerals which a baby needs.
– quality of proteins is different from
that of breastmilk
– contains higher amount of salt,
calcium and phosphate
– chances of infection to the infant
are more
– can cause indigestion and
respiratory infections
– are expensive and less nutritious
– are inferior to
breast milk in all
respect.

Points to Remember

Breastfeeding should be continued even if:
– mother gets pregnant
– child is sick or has diarrhoea
– mother is unwell unless she is too seriously ill to do so.

In case of any problem while breastfeeding like cracked/sore nipples/ swollen and
tender breasts/ lactation failure, mother should consult a doctor immediately.

If a mother has a respiratory infection she should cover her nose and mouth while
feeding the baby.

127
 3.7 Nutrition and Health Care of Infants and Children
(Below 6 Years)
Age of Children Nutrition Care Health Care
0-6 Months
Start breastfeeding within half an hour to 1 hour after birth.
Get regular health

An infant should be exclusively breastfed (not even water) upto six months of age. check up done.

An infant should not be given honey, water sweetened with sugar, glucose and
Immunize the child
jaggery, ghutti or janam ghutti after birth. against BCG, DPT

Breastfeed an infant as often as he/she wants during day and night. and Polio.

Contact a health worker, if mother is not able to breastfeed the infant.

6-12 Months
Continue breastfeeding as long as the child wants.
Get regular health

Foods which are given to the child after the age of six months in addition to check-up done.
breastmilk are called Complementary Foods. These help the child to grow
Immunize the child
adequately and prevent malnutrition. for measles at the

Complementary foods should complement rather than replace breastmilk. Give age of nine months.
128

semi-solid foods 3 times per day if the child is breastfed and 5 times per day if not
Give Vitamin-A
breastfed. along with measles

Following points should be kept in mind while giving complementary food: vaccine.
– Complementary foods that can be given are dalia, rice, suji, kheer, dal, mashed
chappati, milk, curd, seasonal fruits (such as banana, papaya, guava, mango,
etc.), vegetables (such as potatoes, carrots, green leafy vegetable, pumpkin etc.),
meat, fish and egg.
– Complementary foods given to child should be:
 Semisolid in consistency but not watery, inexpensive and easy to prepare,
preferably from foods available at home (feeding from ‘Family Pot’)
 Easy to digest, freshly prepared, clean and less spicy.
 High in calories and should provide proteins, Vitamin A, iron etc.
 Add a little ghee/oil and green leafy vegetables to mashed roti/rice/ bread/
or khichri.
– Introduce one food at a time and add variety.
– Practice Active feeding.

Children can also be given Supplementary Nutrition provided at AWC.
 Age of Children Nutrition Care Health Care

Breastfeeding should be continued as long as the child wants.
Get regular health
12 Months – 2
Years
Feed the child 5 times per day. check up done.

Give adequate servings of foods such as rice, dal, chapati, biscuits, milk, curd, seasonal
Give Vitamin A
fruit (such as banana, guava, mango, etc.), vegetables (such as potatoes, carrots, green solution at an
leafy vegetables etc.) meat, fish and eggs. interval of

Increase the quantity gradually and the child should be given non-spicy food. Use 6 months.
only iodized salt for the child.
Immunize the

Actively feed the child and encourage the child to eat himself. child for DT

By the time the child is 11/2 years, the child should eat half the food an adult eats. (booster dose)

Continue feeding during illness. vaccination.

Give Supplementary Nutrition provided at the Anganwadi Centre.
129

(2-5 Years)
Feed 5-6 times a day.
Get Regular health

Feed adequate quantity of family foods three times a day. Also give nutritious snacks check up done.
such as pakoras, biscuits, chikki, ladoos, panjiri, peanuts and gajak 2 times a day
Give Vitamin A
between family meals solution at an

Observe the amount of food the child eats to ensure that he is eating enough. Use interval of 6
only iodized salt for child's food. months and

Encourage the child to eat himself. He should be given foods that she/he can hold immunize the child
and eat. for DT Vaccine

Caregiver should encourage the child to try new foods by showing that she/he also
likes the foods.

If a new food is refused, small amounts as “tastes” should be repeatedly offered over
several days.

Eating every day at the same time helps the child to have a good appetite and he
eats more.

Give Supplementary Nutrition provided at the Anganwadi Centre.
3.8 Feeding Problems among Children
Some of the feeding problems which mothers face while feeding children along with the
suggested solutions are given below:
Infants 0-6 months
Feeding Problems
Mother is not breastfeeding exclusively
Suggested Solutions

Breastfeed at least 8 times during day and
night

Do not give glucose water, tea, top milk,
porridge and even water. This will
reduce the protection given by breastmilk

Mother feels she does not have enough
breast milk

To increase her breastmilk she should
– Breastfeed the baby more often and
for longer period at each feed
– Breastfeed during the day and at
night
– Eat more and drink more fluids

Mother goes out to work and is not able to
feed the baby

Mother should breastfeed the baby often
before going to work; after returning from
work; and at night

If possible, she should take the baby to
work and she must take brief breaks from
work to feed the baby

Mother should express her milk and keep
it for baby in her absence.

Mother has flat or inverted nipples and cannot
Teach the mother to gently pull the nipples
feed the baby and massage them with oil (do not use
mustard oil) this should be done 3-4
times per day

Refer to a doctor if the problem does not
improve in 2-3 days

Mother has very sore nipples or swelling in
Refer to a doctor

the breast
Breastmilk should be expressed regularly
every 2 hours

If the breast is infected, throw away the
expressed breast milk

130
 Feeding Problems
Child is fed by a bottle
Baby is not able to breastfeed
Child is given diluted animal milk
Infants 6 months to 12 months
Feeding Problems
Mother has discontinued breastfeeding. She
considers child is too old to breastfeed
Complementary food is not being given
Complementary food given in very small
amount
131
Suggested Solutions

Advise the mother to stop bottle feeding.
This can be very harmful

Put the baby to breast every time baby is
hungry, and feed for as long as the baby
suckles

Since breast milk may take 3-4 days to
improve, feed the top milk by a cup.

There may be problem in suckling
position or attachment. Refer to a doctor/
health worker who can help mother to
overcome the problem

Try and increase breastfeeding by
increasing the frequency and by feeding
for longer time

Animal milk must never be diluted

If mother is very worried that animal milk
is too strong, advise her to give plain
clean water after the feed
Suggested Solutions

Breastfeeding can be done upto 2 years
age.

Ask mother to resume breastfeeding by
putting the baby to breast every 2-3
hours. Breast milk will come back after
3-4 days

Tell mother that breast milk alone is not
sufficient for the child, he has to be given
other foods along with breastmilk

Increase complementary foods by 1 tea
spoon per feed until the child takes
1
/2-1 cup or 1/2 katori

If the child cannot take large amount
of food , feed 3-5 times/day.
Infants 6 months to 12 months
Feeding Problems
Complementary food given is very thin
Child takes breastmilk and other milk also
Child does not want to eat complementary

food
Child spits out the food given
Children 12 months to 2 years
Problems
Child is not actively fed
Suggested Solutions

Prepare suji, kheer, rice, dalia with
undiluted animal milk (add butter/ghee)

Give mashed banana or potato with
butter or ghee

Give thick dal with added oil

Continue breastfeeding but stop other
(animal) milk

Replace other milk by complementary
foods mentioned above
Offer the child its most favourite food

Play with the child or distract him while
feeding (Practice active feeding)

If ill, child may be fussy, mother will have
to be more patient and persistent while
feeding the child

Do not place the food on tip of the tongue.
All children will spit out the food if placed
on tip of the tongue

Place the food inside the mouth
Solutions

Mother or caregiver should feed the child

The food for the child should be in a
separate bowl

The mother/caregiver should talk to child
while feeding
132
3.9 Nutrition and Health Care of Adolescent Girls

Adolescence, a period between 11 to 18 years, is a crucial phase in the life, as it is a period
of shift from childhood to adulthood and is marked by onset of puberty resulting in physical,
emotional and social changes.

Physical changes in adolescent girls include:
– rapid gain in weight and height
– development of breasts
– widening of hips
– onset of menstruation
– more fat deposits in certain parts of the body etc.

Adolescent girls need special nutrition and health care.

Nutrition Care

Adolescent girls need a variety of foods and
balanced diet to remain strong and healthy.

Adolescent girls should increase food intake
to accommodate “growth spurt” and to
establish energy reserves for pregnancy and
lactation.

Adolescent girls should ensure intake of
foods rich in iron and vitamins and other
nutrients.

Health Care

Girls start to menstruate between 9-13 years of age, the period of menstruation can last
between 2-8 days every month.

Girls loose blood during menstruation leading to anaemia. Therefore they should take
IFA tablets.

Adolescent girls should maintain personal
hygiene and cleanliness during
menstruation. For this, they should take
bath daily, use clean cloth/sundried
napkin/pad and take adequate rest.

During adolescence, rapid mental
development takes place resulting in
development of skills and ability to think,
explore and question.

Adolescent Girls should give special
attention to physical exercises. The daily
routine should include physical fitness programme or exercises like jogging, yoga asans
etc. and meditation.

133
Information and Education

Adolescents Girls should be given right
information about:
– Human Body, its functions and
requirements.
– Personnel hygiene
– Environmental sanitation
– Iron deficiency and anaemia
– Nutrition
– Home nursing and first aid
– Adolescent reproductive health
– HIV/AIDS and Adolescence and its
prevention
– STIs/RTIs
– Child care and development
– Rights and legal status of women
– Home economics
– Entrepreneurial attitude and
motivaion
– Family Life Education including
appropriate age of marriage, birth
spacing and family planning.
– Family values and norms
– Social issues and problems
– Higher education and vocational
training
– Qualities and responsibilities of a
good citizen

Characteristics of Adolescent Girls

Rapid Physical Growth

Changes in Physiological Processes in the Body

Increased Nutritional Needs

Mental, Intellectual and Emotional Maturity

Move towards Independence

Peer Group Dependence / Pressure

Self Identity & Sense of Self Esteem

Adaptation of New Habits and Trends

Exploration and Experimentation

134
3.10 Common Childhood Illnesses &
Deficiency Diseases: Identification,
Prevention and Treatment
3.10.1 Malnutrition

Malnutrition is a condition, which occurs when the body requirements for one or more
nutrients are not met. This can be either due to inadequate dietary intake of nutrients or
due to non-availability of these nutrients to the body or due to frequent infections or
other metabolic causes.
Intergenerational Cycle of Malnutrition

Malnutrition perpetuates across life cycle. Young girls who grow

poorly, become stunted women and give birth to low birth weight
(LBW) infants, who do not grow to their full potential as adults. In
our country, among children below six years, nearly every fourth
child out of ten is malnourished.

135
 Effects of Malnutrition

Poor or no physical growth
– Growth failure/retardation
– Reduced capacity to fight infection
– Muscle wasting
– Loss of appetite
– Low IQ and mental dullness (Less alert)
– Reduced learning ability & school
performance
– Tiredness, inactive and irritable
– Takes time to recover
– Low immunity
– Low income earning capacity as adults
The first two years of life are crucial in terms of occurrence of
malnutrition and its serious consequences.
136
Causes of Malnutrition
A. Related to Nutrition

Discarding colostrum
– Delayed introduction of breast milk
– Delayed introduction of complementary
foods
– Bottle feeding
– Low intake of foods providing protein
and energy
– Unhygienic feeding practices
– Not feeding the child properly during
illnesses
B. Related to Health

Diarrhoea – Loss of nutrients
– Frequent illness – loss of appetite
– Low birth weight child
– Inadequate care of children, women
and adolescent girls
– Lack of personal hygiene
– Lack of access to basic health services
– Poor environmental sanitation
C. Related to Social Issues

Early marriage
– Traditional beliefs and taboos
– Large family size
– Lack of resources (poverty & inability
to buy food)
 Classification and Assessment of Malnutrition
Classification of Malnutrition

Low Weight for Age or Undernutrition
Undernutrition
is caused by inadequate intake of food
and frequent infections.

Low Height for Age or ‘Stunting

Stunting
Stunting’ or
Stunting
Short Stature is the result of being
malnourished for a long period.

Low Weight for Height or ‘Wasting

Wasting
Wasting’
Wasting
is caused by short-term malnourishment,
insufficient dietary intake, frequent
infections and inadequate supply of
food.

137
138
3.10.1.1 Protein Energy Malnutrition

Malnutrition resulting from deficiency of energy or total calories and proteins is known as
Protein Energy Malnutrition (PEM).

Effects of PEM are evident from inadequate growth, poor weight and height, anaemia,
inability to do hard work and oedema, etc.

Forms of PEM

Kwashiorkor Marasmus
Symptoms Symptoms

Weight usually 60 per cent less than the
Head disproportionately large with little
expected (depends on oedema) hair

Low height
Low height and weight (below 60 per
cent of the expected weight)

Apathy

Pigmented or peeling skin lesions

Moon face

No muscle mass – ribs can be seen

Scanty, lusterless hair
Disinterested in environment and is

Oedema - swelling in legs due to immobile
accumulation of fluids
Lethargic – sits or lies in same position

Pigmented patches, peeling and for hours together often with eyes
ulceration in skin closed

Loss of appetite – does not eat or spit
out

Looks like an old man

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Prevention and Management of PEM
During Pregnancy
– A Pregnant woman must eat one fourth more in addition to her normal diet during
pregnancy.
– She should eat nutritious diet and include green leafy vegetables, fruits and other
vegetables daily.
– Pregnant women should take IFA tablets regularly
– Pregnant women and nursing mothers should take supplementary nutrition (SN) provided
at AWC

Infants (Birth to six months)

– Encourage early initiation of breastfeeding and colostrum feeding.
– Encourage exclusive breastfeeding (no water) for six months.
– Weigh the child every month to keep a record of her growth.
– Provide timely immunization and promote good hygiene practices.

Infants (6 months to 1 Year)

– Introduce adequate, safe and timely complementary foods at the age of 6 months
along with breastfeeding.
– Regular health check up, immunization and administration of Vitamin A between 6-9
months of age.
– Use of iodised salt
– Weighing the child every month and monitoring the growth.
– After 6 months infants should take supplementary nutrition given at AWC.
– Promote good personal/food/water/hygiene practices

Early Childhood 2-6 Years

– Child should be fed from the family pot
– Practice ‘Active Feeding’ i.e. interacting with the child by encouraging & helping him
to eat by himself.
– Feeding during illness especially during diarrhoea to be continued.
– Regular health check-up of children
– Weigh the child every month and monitor the growth.
– Improved practices of clean drinking water, personal hygiene and environmental
sanitation
– Intake of supplementary nutrition provided at AWC regularly.
Adolescent Girls (11-18 years)
– Ensure intake of nutritious and balanced diet
– Encourage intake of iron rich foods.

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 Guidelines for Management of
Malnutrition in Children

These guidelines are designed to help the CDPO, Supervisor and Anganwadi Workers
to take necessary steps for improving the weight of Grade I and Grade II malnourished
children. However, these guidelines would be helpful for management of all
underweight children including Grade III and IV.

• Inform the mother, father or guardian of the child that the child is suffering from
malnutrition and requires additional attention.

• Explain the adverse effects of malnutrition to the parents and to the community

• Make Grade I and Grade II malnutrition visible to the parents

• Explain the rapid growth of the child and the need for adequate feeding to achieve
optimum growth and development

• Emphasise the importance of breastfeeding for children upto two years and the absolute
necessity of adequate complementary feeding from six months of age

• Emphasise that 'additional feeds' are absolutely essential for children to help them to
overcome malnutrition. infant and young children need to be fed 5-6 times a day in
addition to breastfeeding. Optimum feeding is essential to achieve normal weight

• Educate the mother, father or guardian on types of food to be given to the malnourished
child

• The Aganwadi worker should teach and recommend inexpensive recipes for infants
using local foods like cereals, pulses, vegetables etc.

• Modified family food.

• Infant food mixes

• The Aganwadi Worker should educate the community on protective foods like milk,
curd, lassi,egg, fish and fruits and vegetables like papaya, mango, chikoo, banana,
mashed and boiled green leafy vegetables, carrots, pumpkin etc. which help in the
healthy growth of children and in the speedy recovery of the child from malnutrition

• Feeding the girl and the boy child equally needs to be emphasized

• Ensuring the supplementary nature of ICDS food

141
• Provide additional food to Grade I, Grade II, Grade III and Grade IV malnourished children
at anganwadis

• Monitor the growth of children that is weighing the child and plotting on the growth
chart, every month in the presence of their mothers

• Encourage the mothers to come and ask questions regarding the feeding and care of the
child

• Follow malnourished children at home during home visits

• Ensure all vaccinations for malnourished children

• See that the child receives at least nine oral doses of Vitamin A between 9 months and 5
years

• Iron and folic acid tablets should be given to children regularly

• Use only iodised salt

• Educate the parents to observe personal and food hygiene in preparing food and feeding
children

142
• Deworming of all children should also be undertaken and its record maintained at the
Anganwadi

• Children with severe malnutrition having mild or moderate odema and good appetite
but are not severely wasted can be treated at home

• Children with severe malnutrition and complications should be referred to hospital.

• Ready to Use Therauptic Foods (RUTF) are useful to treat severe malnutrition without
complication at home with limited access to appropriate local diets for nutritional
rehabilitation

• Children with severe malnutrition without complications can be managed at home with
nutrient dense foods and by means of carefully designed diets using low cost family
foods provided appropriate minerals and vitamins are given

• Treatment of young children should include support for breast feeding and messages on
appropriate infant and young child feeding practices

• Children less than six months should not receive ready to use RUTF food nor solid family
foods. These children need milk based diets their mothers to support to reestablish
breastfeeding. They should not be treated at home.

143
 Nutritious Recipes for Children
Paushtik Cheela
Ingredients
Wheat flour 50g
Besan 25g
Drumstick leaves 25g
Bengal gram leaves 25g
Fat/Oil 10g
Salt and condiments - according to taste
Method
• Wash and cut the leafy vegetables.
• Mix with wheat flour, besan, salt and make thick batter.
• Pour one ladle full of batter on greased tava and cook both
the sides with oil.

Nutritive Value
Energy 351 K.cal
Protein 12.9 g
Iron 9.45 mg
Carotene 435 ug
Folic Acid 79 ug
Calcium 232 mg
Riboflavin 0.14 mg
Vitamin C 45 mg
Zinc 1.9 mg

50% RDA (mean) for 6 months - 6 year old children

Iron 7.5 mg
Iodine 50 ug
Folic Acid 20 ug
Zinc 5 mg
Calcium 225 mg
Riboflavin 0.5 mg
Vitamin C 20 mg
Vitamin A 200 ug
Vitamin B12 0.5 ug

144
 Leafy Khichri
Ingredients
Rice 50g
Moong dal 20g
Turnip greens 50g
Tomato 25g
Gingelly seeds 20g
Salt & condiments - as per taste
Fat/oil 10g
Method
• Wash rice and moong dal
• Wash and cut tomatoes and turnip greens in small pieces
• Roast gingelly seeds
• Heat oil and put all the ingredients, salt, condiments and
required water into the vessel and cook till soft.

Nutritive Value
Energy 533 K.cal
Protein 12.2 g
Iron 18.4 mg
Zinc 3.5 mg
Folic Acid 28 ug
Calcium 667 mg
Riboflavin 0.47 mg
Vitamin C 105 mg
Carotene 297 ug
50% RDA (mean) for 6 months - 6 year old children
Iron 7.5 mg
Iodine 50 ug
Folic Acid 20 ug
Zinc 5 mg
Calcium 225 mg
Riboflavin 0.5 mg
Vitamin C 20 mg
Vitamin A 200 ug
Vitamin B12 0.5 ug

145
 Paushtik Laddoo
Ingredients
Jowar flour 15g
Wheat flour 15g
Bengal gram flour 20g
Groundnut 15g
Jaggery 25g
Oil/Ghee 10g

Method
• Heat Ghee/Oil
• Roast Jowar, wheat, and bengal gram flour on slow fire till
golden brown.
• Add roasted groundnut and grated jaggery.
• Remove from fire and make balls.

Nutritive Value
Energy 444 K.cal
Protein 12.18 g
Iron 8.89 mg
Zinc 1.51 mg
Folic Acid 40.99 ug
Calcium 54.6 mg
Riboflavin 0.10 mg
Carotene 44.24 ug

50% RDA (mean) for 6 months - 6 year old children

Iron 7.5 mg
Folic Acid 20 ug
Zinc 5 mg
Calcium 225 mg
Riboflavin 0.5 mg
Vitamin C 20 mg
Vitamin A 200 ug
Vitamin B12 0.5 ug

146
 Nutritious Mix (Sattu)
Ingredients
Bajra 40g
Rice 20g
Green gram dal 15g
Gengelly seeds 5g

Method
• Roast bajra, rice and green gram dal for 5-10 minutes on
low fire. Roast gingelly seeds separately.
• Grind roasted grains separately into fine powder. Mix all the
powders and sieve. Store in air tight container.

147
 Preparation of Porridge

Nutritious mix 75g

Sugar 15g
Oil/Ghee 5ml
Method
• Add mix in just sufficient water.
• Add sugar and cook for a few minutes.
• Add Oil/Ghee and serve

Nutritive Value
Energy 417.4 K.cal
Protein 11.05 g
Iron 5.64 mg
Zinc 2.49 mg
Folic Acid 47.92 ug
Calcium 97.37 mg
Riboflavin 0.17 mg
Carotene 66.73 ug

50% RDA (mean) for 6 months - 6 year old children

Iron 7.5 mg
Folic Acid 20 ug
Zinc 5 mg
Calcium 225 mg
Riboflavin 0.5 mg
Vitamin C 20 mg
Vitamin A 200 ug
Vitamin B12 0.5 ug

148
3.10.1.2 Micronutrient Deficiency Diseases

Micronutrients are substances, which are required by the body in very small amount for
performing specific functions. If these are not provided in the required amount, it can
cause specific diseases. The deficiency of one or more micronutrients in the body is known
as Micronutrient Malnutrition.

Major essential micronutrients are vitamins i.e. Vitamin A, B, C, & D & minerals like Iron,
Iodine, Calcium, Phosphorus, Zinc and Chlorine.
3.10.1.2.1 Vitamin ‘A’ Deficiency Disorders (VADD)

Deficiency of Vitamin ‘A’ causes a number of deficiency symptoms and defects and also
reduces the capacity of the body to fight against diseases and infections.

Deficiency of Vitamin ‘A’ increases the risk of diarrhoea by three times; doubles the risk of
Acute Respiratory Infections (ARI); and increases duration and severity of Measles and
ARI

Vitamin A

Vitamin ‘A’ is an essential micronutrient which is required for proper growth and good
health.

Vitamin ‘A’ participates in many body functions like:
– It is essential for normal vision
– It supports growth of bones and teeth
– It is necessary for functioning of tissues which line the internal organs and skin
– It protects the children from getting infection and other diseases.

Vitamin ‘A’ is widely present in most of the green and yellow fruits and vegetables.
Spinach and Amaranthus are the cheapest source of Vitamin ‘A’, and darker the
green leafy vegetable is, richer it is in Vitamin ‘A’

Causes, Signs and Symptoms of Vitamin A Deficiency

Causes Symptoms

Low dietary intake of Vitamin ‘A’ rich
Signs & symptoms of Vitamin ‘A’
foods deficiency disorders referred to as

Rapid loss of Vitamin ‘A’ from the body xerophthalmia are ocular i.e. related to
eyes.

PEM and other nutritional deficiencies

As per WHO (1982), Xerophthalmia

Poor nutritional status of nursing covers all ocular changes like
mothers nightblindness, conjunctival xerosis,

Early weaning bitot’s spots, corneal xerosis and
keratomalecia

Poverty

149
Vitamin A Deficiency if untreated and is prolonged, gradually results
in complete blindness

Clinical Signs and Changes in Eye due to Vitamin A Deficiency Disorders

Stage-1 Eye Inflammation

Early symptoms start with itching, burning
and inflammation of eyelids

Stage-2 Nightblindness
The first symptom of Xerophthalmia is that
child cannot see in dim light and after it gets
dark or in a dark room.

Stage-3 Conjunctival Xerosis

If untreated and Vitamin A deficiency is
severe and prolonged, the conjuctiva
becomes dry, wrinkled and muddy.

Stage-4 Bitot’s Spots

Bitot’s Spot (white foamy patches) form on
either side of cornea. The child does not
like to look towards light and keeps the eyes
closed or sits/lies with her face away from
the source of light.

Stage-5 Corneal Xerosis

Cornea appears dull, dry and eventually
becomes opaque

Stage-6 Keratomalecia
Keratomalecia develops, which is a grave
emergency. The cornea becomes soft,
ulcerated & bursts open resulting in total
blindness

150
 Treatment of vitamin A
Deficiency Disorders

Children with clinical signs of
vitamin A deficiency must be
treated urgently.

Children above 1 year of age,
suffering from Vitamin A
deficiency, on diagnosis, must be
administered immediately a single
oral dose of 2,00,000 I.U. of
Vitamin A followed by another
dose of 2,00,000 I.U. within a
month.

Infant & young children suffering
from illnesses like diarrhoea,
respiratory infections & measles
must be monitored closely and
encouraged to consume Vitamin
A rich foods.

Excessive dose of Vitamin A may
cause nausea, vomiting sleep
disorders, skin lesions and
enlarged liver etc.
151
Guidelines for Use of vitamin
A Solution

Vitamin A concentrate is available at
PHC or sub centre in the form of
flavoured syrup at a concentration of
1,00,000 I.U./ml.

Vitamin A syrup should be
administered using 2 ml spoon/
dispenser provided with bottle.

Vitamin A solution must be kept
away from direct sunlight. It should
be stored in a cold dark room.

Vitamin A solution is stable at room
temperature for a minimum of one
year.

Vitamin A solution bottle once
opened must be utilized within 6-8
weeks.
Prevention of Vitamin A Deficiency

Promoting Consumption of
Vitamin A Rich Foods Vitamin A Supplementation

Administration of dose of Vitamin A to
a. Regular dietary intake of Vitamin A rich
preschool children at periodic intervals
foods by pregnant women, lactating
is simple, effective and direct preventive
mothers and by children under 5 years measure.
of age

b. Initiate breastfeeding immediately after

birth as colostrum is rich in Vitamin A.
Food Fortification
c. Incorporation of locally available

Vitamin A can be easily added to several
Vitamin A rich foods during foods like milk powder, cereals,
complementary feeding weaning foods, oils, vanaspati etc. In
addition, rice, sugar, salt, tea can also
d. Increased use of milk and milk be fortified.
products

Foods fortified with Vitamin A should be
e. Educate pregnant & lactating mothers consumed.
about the importance of consuming
Vitamin A rich foods

f. Growing Vitamin A rich foods such as Public Health Measures

papaya, mango, guava, spinach, and
amaranthus, etc. in kitchen garden.
Breastfeeding protects against
Vitamin A deficiency during first
six months of infancy.

Provision of safe drinking water

Improvement of personal hygiene and
environmental sanitation

Immunisation against measles

Measures to prevent Acute Respiratory
Infections

Role of AWW

AWW should be involved in distribution and administration of Vitamin A.

Mother-infant Immunization Card (Jaccha Baccha Card) may be used to record and
monitor the administration of Vitamin A.

A camp approach may be used for administering Vitamin A to children
1-3 years and 3-5 years.

Nutrition and health education to mothers is essential.

152
3.10.1.2.2 Iron Deficiency Anaemia

Iron is essential for healthy growth and development including formation of

haemoglobin, development of brain, regulation of body temperature and muscle activity
etc.

Iron deficiency in diet leads to Nutritional Anaemia. In addition, deficiency of Folic
acid and Vitamin B12 also contribute to Anaemia

Anaemia is a widespread health problem affecting infants, children, adolescent
girls and women of reproductive age.

Signs & Symptoms Causes Treatment

Increased tiredness,
fatigue and lethargic

Breathlessness

Giddiness

Loss of appetite

Paleness of skin, eyes, lips
and tongue

Spoon shaped/flat nails

Palmar Pallor (Paleness of
Palms)

Low dietary intake of

Children and adults
iron rich foods in all age
with severe anaemia
groups and at all stages
should be referred to

Low iron absorption by
PHC/Hospital
gut immediately for

Worm infestation diagnosis of causative

Malaria factors and treatment.

Excessive menstrual

Children with anaemia
flow
may be first treated for

Anaemic pregnant
worm infestation with
women
Mebendazole.

Inadequate stores of
iron in new born
babies, if mother is
anaemic
Consequences

Reduced work
capacity and physical
performance

Reduced learning
ability and cognitive
functions

Reduced resistance
against diseases

Increased morbidity
and mortality

Anaemia during
pregnancy increases
the risk of premature
deliveries, low-birth
weight babies, maternal
& neonatal deaths

153
Prevention of Anaemia

1. Promoting Consumption of Iron Rich Food

Regular dietary intake of iron and folic acid rich foods by pregnant and lactating mothers,
adolescent girls and children under 5 years of age should be promoted.

Ensure incorporation of iron rich foods such as green leafy vegetables in the
complementary foods of infants.

Vitamin C (ascorbic acid) rich foods, germinated/ sprouted and fermented foods
promote absorption of iron. Regular consumption of Vitamin C rich foods should be
promoted.

Tea/Coffee inhibits absorption of iron. Advise reduced consumption of tea, specially
during pregnancy for improving the absorption of iron and prevention of anaemia.

2. Promoting Consumption of Iron and Folic Acid Supplements

As a priority, all pregnant women irrespective of haemoglobin levels, must be provided
with the recommended dose of iron and folic acid supplements.

3. Food Fortification

Use of iron fortified processed/ready-to-eat foods for children such as milk, potato chips,
biscuits, candy and sugar may be promoted.

4. Public Health Measures

Control of malaria

Control of worm infestation

Providing safe drinking water

Creating awareness on personal hygiene and sanitation

Role of AWW

Ensure that pregnant women are provided with complete recommended dosage of iron
and folic acid tablets during pregnancy.

Supervise, monitor and keep a record of distribution of iron and folic acid tablets.

154
3.10.1.2.3 Iodine Deficiency Disorders

Iodine

Iodine is essential for normal growth, development and functioning of both brain and
the body.

Iodine is not produced in the body and is required
in a small amount, by both children and adults.

Iodine content of water and food is determined
by the iodine content of the soil in which they
grow.

Iodine is present mainly in sea foods like fish,
prawns, etc.

Lack of iodine in the environment has serious
consequences on both humans and animals.

Consequences of Iodine Deficiency

Goitre - an abnormal swelling in the neck

Energy loss

Mental retardation – Low I.Q. level (lower by 10-15 points)

Impaired learning & pre school activities – low motivation and curiosity, reduced play &
exploratory activities.

Growth failure

Infant deaths

Reproductive losses
– Spontaneous abortions/ miscarriages
– Still births.
– Irreversible brain damage in unborn baby

Goitre
Symptoms

The most visible and easily recognizable sign
of iodine deficiency is Goitre – an enlarged
gland in the neck, which can range from an
invisible swelling to a size of a coconut or even
larger

Goitre also affects physical growth and mental
development

Children of parents suffering from goitre are
prone to become cretins i.e. dwarfs with
retarded mental growth.

155
 Prevention

Goitre cannot be treated by making
changes in the diet.

The daily and regular consumption of
iodized salt provides protection
against IDD.

As Iodine present in the salt can
evaporate while cooking, it is
important to cover the food while
cooking.

Consumption of sea foods also
prevents IDD.
Treatment
Refer to PHC/Hospital

Iodine Testing Kit

The iodine content of salt varying from 15-30 ppm can be detected at household level by
the use of Iodine Testing Kit. The Iodine Testing Kit contains a vial with chemical solution.
One drop of chemical solution turns salt sample violet, if it contains iodine depending
upon the level of iodine concentration. The minimum iodine content of salt at
consumption level should be 15 ppm.

Role of AWW

Create awareness about use of iodised salt.

Educate mothers and adolescent girls.

156
3.10.2 Cough, Cold and Acute Respiratory Infections (ARI)

ARI is the major cause of death among children. On an average children below 5 years
of age suffer about 5 episodes of Acute Respiratory Infections (ARI) per year.

Cold, cough, sore throat and running nose are common respiratory infections and are
of no cause of alarm. In some cases, cough and cold are danger signs of more serious
respiratory infections as Pneumonia and Tuberculosis.

Cough and Cold

Cough and common cold is the most frequent problem in childhood and is usually
due to infection of the upper respiratory tract.

Cough is a sign of some other sickness affecting the throat, lungs or air passage in the
chest.
Symptoms Home Treatment and Care

Keep the child warm and let him rest
Running nose, sneezing, sore throat and

Encourage the child to eat normally
cough.

Increase the amount of fluids including
Treatment breastfeeding.

Children with cough, cold, running nose
Soothe the throat and relieve the
or sore throat who are breathing cough with safe home made cough
normally can be treated at home and remedy i.e. Ginger tea with honey;
will recover without medicine. lemon drink; Drink with tulsi leaves,
saunf and elaichi; hot soups etc.

A child with harsh cough requires

Sponge/bathe with cool but not cold
immediate referral.
water if child has fever.

Clean the nose by putting in nose drops
(boiled and cooled water mixed with
salt) or by cleaning the nose with a soft
cotton wick. A moist atmosphere can
make breathing easier.

Medication should be used only if
prescribed by a doctor.

Pneumonia
Symptoms

A child with cough and cold and fast
breathing has Pneumonia.
Assessment

To assess whether the child has fast
breathing or not count the breathing
rate for one minute.

Breathing rate of a child is as per his
age. As the child grows older,
breathing rate slows down.
Treatment

A child having Pneumonia is treated
with Cotrimoxazole.

Cotrimoxazole is not provided in the
Medicine Kit of AWW. She may
contact ANM immediately, who can
prescribe the medicine and has it in
her stock.

157

While counting the breathing rate, chest and abdomen must be exposed

A child’s breathing rate is fast if you count:
– 60 breaths per minute or more in an infant below two months
– 50 breaths per minute or more in an infant between 2 months - one year.
– 40 breaths per minute or more in a child between 1 year - 5 years.

Prevention

Million of child deaths from pneumonia can be prevented if:
– Parents and caregivers know that rapid and difficult breathing are danger signs requiring
urgent medical help
– Parents and caregivers know where to get medical help
– Medical help and low cost antibiotics are readily available.
– Babies are exclusively breastfed for first six months and are fully immunized.
– Children and pregnant women are particularly at risk if exposed to smoke from tobacco
or cooking fires.

How to give Cotrimoxazole ?

Cotrimoxazole is available in the form of tablets and is given by mouth twice in a day
i.e. every morning and every evening for five days.

All the tablets must be used to finish the five day course treatment
treatment, even if the
child gets better before the medicine is finished

Avoid Cotrimoxazole, if an infant is premature or has jaundice.

Show the mother how to crush and mix the tablet with fluid or food, as given below:
i) As a baby will not be able to swallow the tablets, the tablet is crushed into a
powder
ii) Mix it with a small amount of breastmilk or clean drinking water or porridge or
banana or some other food that the child eats.
iii) Ask the mother to give the medicine to the child in your presence.
iv) If the child vomits, the medicine should be given again.

As a follow up, the child should be checked again after 2 days.

158
 Severe Pneumonia
Symptoms

If a child with cough and cold has chest indrawing
indrawing, he has Severe Pneumonia.

Normally, the lower chest wall comes OUT when the child breathes IN. In case of
Severe Pneumonia the whole of lower chest wall goes IN as the child breathes IN. This
is called chest indrawing
indrawing.
Assessment

To assess Severe Pneumonia, look for chest indrawing at the lower chest wall when the
child breaths IN.

Make sure that the child’s lower chest is fully exposed, child is not crying and child’s
nose is not blocked.
Treatment

Refer the child with chest indrawing to PHC/hospital immediately, as this is a specific
danger sign.

When to Return Immediately to AWC/PHC

Mother should bring the child to AWC/PHC immediately, if the child has:
– Difficulty in breathing
– Not able to drink
– Lethargic & unconscious
– Vomits persistently
– Chest indrawing

Points to Remember
Assessment, Classification and Treatment of ARI

When a child suffering from cough and cold is brought to an AWC, always check for
the following:
1. Look for danger signs
– Ask if the child is able to breastfeed or drink
– Look if the child is lethargic or unconscious
– IF the child has danger signs refer the child to PHC/Hospital.
2. If NO danger signs are present, look for Chest Indrawing
– If YES, the child has Severe Pneumonia
– Refer the child to PHC/Hospital.
3. If NO chest Indrawing, count child’s breathing rate.
– If the child has fast breathing, the child has Pneumonia
– Treat the child with Cotrimoxazole
4. If the child does not have fast breathing, the child has cough and cold.
– Give the child home treatment

Note: An AWW should refer the child with cough & cold and chest
indrawing or fast breathing to PHC/Hospital immediately

159
3.10.3 Diarrhoea

A child has diarrhoea if he/she passes three or more watery stools per day

Diarrhoea is more common among undernourished children than in normal children

Diarrhoea kills children by draining liquid from the body thus dehydrating the child.

If diarrhoea continues for more than two weeks, it is persistent diarrhoea
diarrhoea. In this
case, the child needs immediate attention and should be referred to PHC/Hospital.

If a child has blood in stools, he/she has dysentery and should be referred to PHC/
Hospital.

Causes of Diarrhoea
– Dirty and unhygienic conditions
– Unsafe water
– Malnutrition
– Unhygienic feeding practices
– Over eating of spicy and greasy foods
– Bottle feeding
– Bacterial/Viral infections
– Lack of personal hygiene
Germs causing diarrhoea occur in dirty & unhygienic conditions.

Danger Signs of Diarrhoea

If a child suffering from diarrhoea has the following danger signs he/she should be
referred to PHC/Hospital:
– passes several watery stools – is extremely thirsty
– passes blood in stools – unable to drink
– has had diarrhoea for more than two weeks – refuses to eat
– vomits frequently – has sunken eyes
– has fever – is lethargic or unconscious

160
 Classification of Diarrhoea

Mild Diarrhoea No Dehydration - Child drinks normally.
Diarrhoea/No

Moderate Diarrhoea Some Dehydration – Child is thirsty and drinks eagerly.
Diarrhoea/Some

Severe Diarrhoea Severe Dehydration – Child drinks poorly or is not able to drink.
Diarrhoea/Severe

Assessment of Diarrhoea
S.No. Indicators No Dehydration Some Severe
Dehydration Dehydration

1. General Well, alert Restless/Irritable Lethargic or

Condition Unconscious

2. Eyes Normal Sunken Very sunken and

dry

3. Thirst Drinks normally, Thirsty, drinks Drinks poorly or

(Offer child not thirsty eagerly not able to drink

water to drink)
4. Skin Pinch Goes back Goes back slowly Goes back very
quickly slowly

Home available ORS Refer to PHC/

Treatment fluids and ORS Home treatment Hospital

As soon as diarrhoea starts, it is essential that the child is given extra

fluids as well as regular food and fluids

161
 Management of Diarrhoea
Best treatment for diarrhoea is to drink lots of liquids to replace the
fluids lost.

Diarrhoea usually cures itself in a few days.

Do not give a child with diarrhoea any tablets, antibiotics or other medicines unless
prescribed by a doctor.

A child with persistence diarrhoea or dysentery or severe diarrhoea should be referred to
PHC/Hospital.

Home treatment of diarrhoea includes:
– Intake of Home Available Fluids
– Oral Rehydration Solution (ORS) Continued Feeding
– Continued Feeding
A child with diarrhoea needs to be fed
– Continued Breastfeeding continuously.

Intake of Home Available Fluids
While recovering from diarrhoea, the

child needs atleast one extra meal every

A child with diarrhoea should be given day for atleast 2 weeks.
extra fluids available at home like soups,

Mother should not stop feeding the
rice water, coconut water, weak tea with
a little sugar, clean water from safe child.
sources, diluted dal, butter milk and
breastmilk (if child is breastfed). Continued Breastfeeding

Fluids should not be diluted, if the fluid

Breastmilk is the best source of liquid
is heavy for the child, plain clean water
and food for a young infant with
can be given to the child after giving
diarrhoea. It can reduce the severity and
fluid.
frequency of diarrhoea.

If the child vomits, wait for 10 minutes,

Breastfeed the baby frequently and for
then continue giving fluids, but more
longer time than usual.
slowly.

162
Oral Rehydration Therapy

Oral Rehydration Solution is a life saving drink and is effective for all ages including neonates
for replacement of fluid losses during diarrhoea.

Oral Rehydration Salt (ORS) may be properly mixed with water to prepare a solution and
given to the child.

Preparation of ORS Solution

1. Read instructions on ORS packet carefully before preparing ORS.

2. Take one litre or five glasses of safe drinking water in a clean container.

3. Empty the content of ORS packet into one litre of water.

4. Mix it well and start feeding the child.

5. During first four hours, ORS is given according to the age of the child (See Box)

Quantity of ORS Given during First Four Hours

Infant (4 mths.) – 2 Cups (200-400 ml)

Infant (4 mths. – 1 yr.) – 3-4 Cups (400-700 ml)

Child (1-2 yrs.) – 5-6 Cups (700-900 ml)

Child (2-5 yrs.) – 6-8 Cups (900-1,400 ml)

163
 HOME MADE SUGAR AND SALT SOLUTIONS

Points to Remember while Giving ORS Solution

Give ORS slowly. Every time the child feels thirsty or passes stool, give ORS

If the child wants more ORS than what is recommended, it should be given.

If the child vomits, wait for 10 minutes. Then continue giving ORS, but more slowly.

Child should be given ORS till he/she begins to pass urine normally and looks normal

Fresh ORS should be prepared every day.

After 4 hours, AWW/Health Worker should reassess the child and give appropriate
treatment.

When to return Immediately

Tell the mother to return to AWC if:

The child is not able to drink or breastfeed

The child becomes sicker

There is blood in stool

The child is drinking poorly.

The child is lethargic/unconscious

Role of AWW

Advise mother to start giving fluids or ORS Solution to the child immediately.

Give ORS packet to mothers

Advise mother to continue breastfeeding the child.

Monitor the progress of the child.

As a follow-up, ask the mother to bring the child to AWC again after 2 days.

164
 3.10.4 Emerging Diseases

Malaria, Dengue fever, Jaundice and HIV/AIDS are some of the diseases which have recently gained public health importance as emerging diseases.

AWW is not directly associated with the treatment of these diseases but she must know the preventive measures and symptoms so that she can refer the child/
mother to PHC/ Hospital.

Disease Malaria Dengue Fever Jaundice HIV/AIDS

(Acquired Immuno
Deficiency Syndrome)
Causes
Caused by mosquito bites
Caused by viral infection due to
Caused by a virus through
Caused by HIV virus through sexual
mosquito bite contaminated food or water contact, contaminated needles, in-
fected blood transfusion and from HIV
positive mother to her baby

Symptoms
Fever, vomiting, lethargy,
It may take several years before the

Sudden onset of fever with severe chills and
Asymptomatic
lack of appetite, fatigue, following symptoms appear:
rigors (shivering). or
headache are the early – Unexplainable loss of

Fever settles with profuse sweating and
Abrupt onset of high fever lasting for
symptoms of the disease weight
returns at regular intervals (36,48,72 hrs.) 2 to 7 days
followed by itching and – Severe tiredness

Headache, body ache and muscle pain
Severe frontal headache
yellowness of eye/skin, dark – Persistent night sweats

Vomiting/drowsiness
Pain behind the eyes
urine, pale stools and joint – Unexplained fever
165

Muscle and joint pain

pains – Chronic diarrhoea

Loss of appetite

Measles like rash over chest and
upper limbs

Nausea and vomiting
and
May be associated with spontaneous
bleeding such as bleeding from
gums, nose, mouth, skin or blood in
urine/stools

Prevention
Care should be taken to keep mosquitoes
away by using mosquito nets/wire mesh/
sprays

Children should be made to wear clothes
that cover arms and legs especially during
evenings

If malaria is common in the area and the child
has fever and vomiting or is drowsy. Health
worker should
– examine the child and start treatment for
malaria immediately
– Refer the child to health centre for blood test
immediately.

Preventive medicine chloroquine may be given
to children during the season by Health
Workers

Mosquito control
– Cleaning of coolers stagnant
waters etc
– Putting one spoon of kerosene oil
/ petrol in collected water like
coolers, tyres etc

Protection from mosquito bite
– Use of nets & repellents etc

Adequate nutrition and
Practice safe sex; condoms should
electrolyte balance may be always be used.
maintained.

Testing of blood before transfusion

Hepatitis vaccination given to
children can prevent infection
Use of disposable syringe and sterilized
needles

Eat well cooked food

Drink boiled water
HIV positive mother should be given
informed choice for breastfeeding the

Maintain personal hygiene &
newborn
environmental sanitation

Ensure proper sewage
disposal
 3.10.5 Disability among Children

Almost 75% of the childhood disabilities can be prevented through timely

detection, and simple health care during pregnancy, childbirth and
infancy.

Disability means any restriction or lack Causes of Disability

of ability to perform an activity in the
manner or within the range considered
Inadequate dietary intake
normal for a human being. Disability is

Complications of pregnancy and child
a result of an impairment.
birth

An impairment is any loss or

Malnutrition
abnormality of psychological,
physiological or anatomical structure
Inadequate maternal and child health
or function or as response by an care
individual to a physical and sensory
Unhygienic living conditions
loss or abnormality. It can be missing

Biological disorders and genetic
or defective body part or paralysis or
diabetes or limited hearing capacity, defects
etc.
Disease, injury and accidents

A disability becomes a handicap when
Accident prone environment
it interferes with one’s ability to do what

Inadequate resources and poverty
is expected at a particular time in one’s
life.
Lack of appropriate referral system

Prevention of Childhood Disability

Proper health care support system

Adequate nutrition of mother during
pregnancy

Intake of adequate micronutrients i.e.
iron, iodine and Vitamin A

Appropriate infant feeding practices

Complete immunization of a child at
the right time

Provision of safe drinking water and
safe environment

Avoidance of accidents/injuries during
and after birth

Access to information for genetic
counselling

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 Types of Disability
Physical and locomotor disability
Loss or lack of normal ability of an individual
associated with moving both himself and
objects from place to place. It can occur due
to paralysis of a limb or body; amputation,
dysfunction of joints of the limb and deformity
in the body.
Visual disability
Loss or lack of ability to execute tasks requiring
adequate visual acuity. Persons who do not
have light perception from both eyes and also
those who have light perception but can not
correctly count fingers of a hand from a
distance of 10 feet in good day light.
167
Communication disability – Inability to
hear or Speech defects
Hearing disability is inability to hear, which
can be classified as:
– cannot hear at all (not hearing loud
sounds).
– Profound hearing disability (hearing only
loud sounds);
– Severe hearing disability (hearing if
speaker is in front); &
– Moderate hearing disability (usually ask
to or feel difficulty in telephonic
conversation or in hearing).
– Speech defects include inability to speak
or voice defects.
Mental disability
A condition of incomplete development of
mind of a person which is specially
characterized by sub-normality of intelligence
Learning Disorders (Above 3 years)

Some children may find difficulty in
reading, writing, learning spellings and
doing sums despite constant academic
inputs.

It is difficult for an AWW to observe/
assess Learning Disorders among
children, as they do not read or write in
AWC as they do in formal school settings.
If a child is not able to learn rhymes/
alphabets like other children of his age,
the child should be referred to hospital.
 Early Disability Detection Checklist
Disability affects the child’s developmental process. AWWs/Village Health Functionaries/Care
givers should refer the children with the following signs to PHC/hospital immediately so as to
prevent any impairment:

By 3 months

Unable to lift head or push up on arms

Pushing back with head

Finding difficult to move out of position
By 6 months

Unable to lift head

Poor head control

Rounded back

Stiff arms

Arms held back

Difficult to get arms forward

Stiff, crossed legs
By 8 months

Rounded back

Poor use of arms for play

Stiff legs and pointed toes

Poor ability to lift head and back

Does not take weight on legs
By 12 months

Cannot crawl on hands and knees

Uses only one side of body to move
By 18 months

Excessive tip-toeing while walking

One leg may be stiff

Holds arm stiffly and bent

Sits with weight to one side

Uses predominately one hand for play
By 24 months

Does not understand simple words/sentences

Cannot tiptoe and walk on heels

Unable to take off simple clothes

Does not play with children
By 36 months

Does not walk backward

Cannot speak small sentences

Does not follow simple instructions

Unable to bathe or dress by himself
By 60 months

Cannot walk with one leg

Does not play throw ball

No interaction with parents/peers.

Unable to follow instructions

168
3.11 Medicine Kit and Treatment of Common
Childhood Diseases and Ailments & First
Aid for Injuries

An AWW is provided with a Medicine Kit for treating common ailments of children and for
providing first aid in case of injuries and accidents.

The cost of each Medicine Kit is Rs.600/-.

Medicines in the Medicine Kit at AWC are:

i) Paracetamol Tablets
ii) Paracetamol Syrup
iii) Mebendazole Tablets
iv) Benzyl Benzoate (For Application)
v) Chloramphenicol Eye Ointment
vi) Sulphacetamide Sodium Eye Drops
vii) Gention Violet
viii) Povidine Iodine Ointment; and
ix) Absorbent Cotton Roll & Cotton Bandage

169
 A. Treatment of Common Ailments of Children
Common Ailment Symptoms Medicine in the Kit Treatment Prevention
Name Dosage Form &
Specification

1. Cough & Cold Running nose, – –
Home Treatment
Keep the child warm and let
sneezing, sore
If the child has fever, treat him rest
throat and cough according to the treatment

Encourage the child to eat
suggested for fever
normally and breastfeed him

A child with harsh and
frequently.
persistent cough requires
immediate referral.

2. Fever Body temperature Paracetamol Tablets packed in a
Dosage

more than 37°C/ white Jar – Children 2 months – 3 years
98.4°F -1/4 tablet of Paracetamol
Syrup in a white
(4 times a day)
bottle of 550 ml.
– Children 3-6 years-1/2
170

Body is too hot tablet (4 times a day)

– Adults – 1 Tablet (4 times a
day)
(Do not give medicine empty
stomach)
Advice to the Mother
– Cold water sponge if
temperature is high along
with medicine
– Do not wrap the child in
warm clothing
– Make child drink lot of
water and other liquids
– Infants below 2 months
with 100°F may be referred
to the hospital
– If the child is not relieved
of fever after two days by
the above treatment or
fever is high, refer the child
to PHC
 Common Ailment Symptoms Medicine in the Kit Treatment Prevention
Name Dosage Form &
Specification

3. Worm
Stomach ache Mebendazole Tablets
For children above two years
Personal hygiene,
Infestation and adults – One tablet to be environmental sanitation,

Anaemia sewage and waste disposal
taken with water twice daily
for 3 consecutive days
Root vegetables as carrot,
radish etc. should be
thoroughly washed before
eating.

Drinking water should be
clean and chlorinated if
possible.

Wash hands before eating
after play and defecation.

Stools should be disposed
171

away from houses and

should be covered with mud

People should not walk
barefoot in place used for
defecation

4. Eye Infection Sore eyes, redness, Chloramphenicol Ointment in a white
Wash the eyes gently with
Proper hygiene including
burning sensation, Eye Ointment coloured tube boiled cooled water with regular washing of face
watering and at pinch of salt.
Sulphacetamide
It spreads from one person to
times pus in one or
Sodium Eye Drops
Pull down the eyelid and put another, so do not let a child
both eyes. Eye drops packed in
2-3 drops of Sulphacetamide to play with other children
amber vial with the
Eye Drops (Repeat 3 times a
help of rubber plug
Use separate towel,
day)
plus eye dropper handkerchief

If rash or itching starts on face,

Wash hands after touching the
refer to the nearest medical
sore eyes.
facility.
 Common Ailment Symptoms Medicine in the Kit Treatment Prevention
Name Dosage Form &
Specification

5. Ear ache Blockage in the ear Sulphacetamide Eye/ear drops
If there is discharge, wipe it
Do not put match stick/wick
may cause pain Sodium Eye / Ear packed in amber away with cotton wool. in the ear for cleaning
accompanied by Drops vial with the help of
Tilt the head to opposite side,

Do not put oil or any other
discharge rubber plug plus pull gently on ear and apply a
medicine without advice of
eye/ear dropper few drops of sulphacetamide
the doctor in the ear.
eye-ear drops

Give Paracetamol if there is pain

Refer the child to PHC if he has
fever.

6. Scabies Severe itching, tiny Benzyl Benzoate Solution packed in
Bathe with soap and water using
Maintain personal hygiene
blisters or cracks in Lotion amber glass bottle a brush to open all the blisters and cleanliness
the skin especially (only for External
While skin is slightly wet, apply

Bath and change clothes daily
172

between the fingers Application) Benzyl Benzoate Lotion over the

whole body, except head and
Prevent children from playing
neck in dirty and muddy

Allow to dry partly and apply surrounding
second layer of Benzyl Benzoate
It can easily spread from one

Leave the lotion on body for 24 person to another. Care
hours. Bathe thoroughly and put should be taken to keep
on clean clothing oneself away from persons

Repeat for three days and after 3 with scabies.
days clothing and bedding
should be washed and sundried
Home Treatment

Boil neem leaves with little water

Grind neem leaves with turmeric
powder to form thick paste and
apply all over the body after
taking bath

Apply for 3 days

On the third day wash all clothes
and bedding and dry in hot sun
 Common Ailment Symptoms Medicine in the Kit Treatment Prevention
Name Dosage Form &
Specification

7. Cuts & Povidine Iodine Ointment packed in
Wash the wound with
Wounds Ointment (wet tube only for antiseptic solution or clean
wounds) external application water

On dry wound apply 2 per
Gention Violet
cent solution of Gention Violet
(dry wound) Lotion in blue

On wet wound apply Povidine
colour bottle
Ointment

To prevent wound from getting
dirty, cover with bandage
lightly

Advise the patient to get an
injection of Tetanus.

If bleeding profusely, apply
173

direct pressure on wound to

stop bleeding and refer to
nearest health facility.

8. Boils and Small collection of Gention Violet Lotion in blue
Apply hot fomentation and let Maintain personal and
Abscess pus under the skin, (dry wound) colour bottle the boil break environmental sanitation.
causes pain and the

Allow the pus to drain out
skin around it
becomes red and
Clean the area gently and
hot and may get apply Gention Violet
fever
Give Paracetamol as per the
recommended dose for fever

Ask the child to drink lot of
water

If not relieved in 3 days, refer
to nearest health facility
 B. First Aid for Injuries & Accidents
Injury / Accident First Aid Prevention

1. Burns and Scalds
Use plenty of cold water to cool the burned area
(from fire, stoves, cooking pots, hot
Use antibiotic/cream/oily substance to soothe the burned
foods, boiling water, steam) area

Keep the burned area clean and protect with a loose bandage

If the child's clothing catch fire, quickly wrap the child in
blanket or clothing or roll her/him on the ground

The child should be taken to health facility, if blisters begin
to form

Keep children away from fire, matches,
candles, lighters, cooking stoves and
lamps

Keep all hot cooking pots away from the
reach of children.

2. Electric shock
Turn off the power before touching the child
Electric wires should be kept out of reach
(from electrical appliances, sockets & of children

If the child is unconscious, keep him warm and get medical
switches)
Keep children away from electrical
help immediately
appliances
174

3. Bruises, broken bones and serious head
falls (fall from cots/window/tables/
stairs)
4. Cuts and wounds (due to knives, scissors,
sharp or pointed objects and broken glass)

Limit movement of the head and back & avoid twisting of
Balconies, roofs, windows and play areas
spine should be made secure to protect children
from falling

If the child is unable to move or is in extreme pain after
fall, he may have broken bones. Do not move the injured
Discourage children from climbing on to
area, instead provide support and get medical help unsafe places
immediately

For a minor cut, wash the wound with clean (boiled &
Sharp or pointed objects like knives,
cooled) water. Dry the skin around the wound and cover it scissors or broken glass should be kept
with a clean cloth or bandage out of reach of children,

If the child is bleeding heavily from the wound, raise the

Household refuse, including broken
injured area and press firmly until bleeding stops. If a piece
bottles and old cans should be disposed
of glass or other object is sticking around the wound, do not
off safely.
remove it as it may worsen the injury and take the child to
health facility.

Mother may be advised not to put any plant or animal matter
on the wound to avoid infection

Take the child to health centre to get medical help
immediately and get a tetanus toxoid injection
 Injury / Accident First Aid
5. Choking
If an infant or child has put some small object in the mouth
and is coughing, do not interfere, let the child try to cough
(by small objects like buttons,
up the object. If the child is unable to release the object,
beads, coins, seeds and nuts)
try to remove it quickly from child's mouth and take the
child to the nearest health facility immediately.
6. Poisons
If a child has swallowed poison, do not try to make the
child vomit and take him/her immediately to health worker/
(Poisons, medicines, chemicals such as
hospital.
acid and kerosene etc.)

The sample of poison or medicine or container may be
carried along to show to the health professional.
175

Keep the child as still and quiet as possible.
7. Drowning
Remove water from child body as early as possible

If the child has breathing difficulty, hold the child's nostril
closed and blow in to the mouth. Blow hard enough to
make the child's chest rise, count to three and blow again
and continue until the child begins breathing.
8. Road Accidents
If a child who is unable to move or is in extreme pain, he
may have broken bones. Do not move the injured area.
Steady and support it and get medical help immediately.

If the child is unconscious, keep her or him warm and get
medical help immediately
Prevention

Playing and sleeping areas should be kept
free from small objects such as buttons,
beads, coins, seeds & nuts as children like
to put things in their mouth

Children should always be supervised
during meals

Very small children should not be given
peanuts, hard sweets or food with small
bones or seeds

All medicines, bleach, acid and kerosene
should be stored in original containers
and should be kept out of reach with clear
markings and tightly sealed.

Over use or misuse of antibiotics can
cause deafness in small children.
Medication should only be used as
prescribed by the health personnel

All wells, tubs and buckets should be kept
covered.

Children should never be left alone when
they are in or near water.

Children should not play near the road

Children should be taught to walk on the
side of the road facing traffic

While crossing the road, children should
be accompanied by elders.
3.12 Integrated Management of Neonatal
& Childhood Illness (IMNCI)
3.12.1 IMNCI Strategy

Every year a large number of children die due to diseases which if prevented at the right
time would have saved the lives of these children.

The major causes of death among children below five years are Pneumonia, Diarrhoea,
Measles, Typhoid, etc.

Widespread undernutrition, low birth weight, anaemia and worm infestation, although,
are not one of the major causes of illnesses, but are important conditions which contribute
towards these illnesses.

Frequently, among children, it is not one disease but a combination of a few diseases
which are responsible for their untimely death. Therefore, while treating sick children,
it is important to look beyond a single disease and address the overall health of the
child in an integrated manner.

WHO has developed a strategy for Integrated Management of Neonatal & Childhood
Illness (IMNCI) which aims to reduce morbidity and mortality and contributes towards
improved growth and development of children.

176
3.12.2 How can an AWW adapt an IMNCI Strategy in ICDS?
· At present AWW is treating sick children with single diagnosis approach i.e. treating one
illness at a time.
· Integrated approach means treating more than one illnesses at a time. For this, whenever a
sick child is brought to an Anganwadi, he/she should always be checked for symptoms of
common diseases prevalent among children like ARI, Diarrhoea, Undernutrition, Anaemia,
Fever and other ailments irrespective of the fact whether the child has symptoms of all
these diseases or not.
· Steps involved in treating a sick child following an integrated approach are as given below:
1. Assessment
2. Classification of Illness
3. Treatment
– Referral
– Medicine
– Home Treatment
4. Advising Mothers
– Feeding Advice
– Fluid Intake Advice
– When to return immediately
5. Follow-up Visit

An AWW is to maintain a Register to keep the record of sick children at the AWC.
A sample of Record Sheet is at Page160.

An AWW is to only circle the relevant signs, illnesses & treatment on the Record Sheet.
She need not write anything.

On a single Record Sheet of the Register, an AWW can keep the record of Assessment,
Classification of Illness, Treatment, Advice given to a mother and Follow-up of a sick
child. One Record Sheet is to be used for one child.

177
 Instructions for Filling up a Record Sheet
1. On a Record Sheet enter the name, weight, age and temperature
of the sick child.
2. Do the complete Assessment of the sick child by asking questions
or by observations. Steps for assessment are given at Table (Page
No. 159).
3. Circle the ‘signs’ told or observed of the Illness in the column
Signs
Signs’ of the Record Sheet.
‘Signs
4. Under the ‘Classification Column’ circle the Illness Classified
against the signs circled.
Treatment’ column circle the treatment given for
5. Under the ‘Treatment
Treatment
the illness. This can be ‘Referral’ or ‘ ‘giving medicine’ or ‘Home
Treatment’.
Referral Slip
6. Prepare the ‘Referral Slip’ for a child who is to be referred to
PHC or hospital and give necessary instructions to the mother.
7. Advise the mother for giving food or fluids to a child and tell
her when-to-return immediately
immediately.
8. Fill up the date column for Follow-up Visit
Visit.
9. During Follow-up Visit, again assess the child and give treatment.

When to Return Immediately

– Child can not drink
– Child can not drink mother’s milk
– Child is lethargic or unconscious
– Difficulty in breathing
– Breathing is rapid
– Chest Indrawing
– Blood in the stool
– Child vomits on drinking

Follow-up Visit
Child’s Condition Time of
Follow-up
Pneumonia 2 Days
Diarrhoea 2 Days
Feeding Problems 5 Days
Anaemia 2 Weeks

178
179
3.13 Personal Hygiene and Environmental
Sanitation
More than half of all illnesses and deaths among children are caused
by germs that get into the body through food, water or dirty hands. In
order to remain healthy, we should maintain personal hygiene and keep
our environment clean.

Personal Hygiene

All family members including children
need to wash hands with soap and
water or ash and water after going to
the toilet.

Mud should not be used for washing
hands as this itself can have germs of
diseases. If the soap is not available,
use fresh ash. Both hands need to be
rubbed while washing.

Children often put their hands into
their mouth, so it is important to wash
child’s hands often, especially after
they have been playing in dirt or with
animals.

Taking bath daily and changing clothes
help to prevent illnesses.

Do not spit inside the house and on
the walls.

Children living in areas where worms
are common should be treated two or
three times per year with a
recommended deworming medicine. Food

Latrines and Bathrooms should be
Hands must be washed before cooking
cleaned frequently. Latrines should be or serving food as well as before and
kept covered and toilets should be after eating food.
flushed.

All fruits and vegetables should be
thoroughly washed before eating/
cooking. As far as possible freshly
prepared food should be eaten.

Food should be kept covered to remain
protected from flies and other insects.

180
 Water

Water from safe sources such as tap,
tube wells, wells and springs should
be used for household purpose.

Water from unsafe sources such as
ponds, rivers, open tanks and step-
wells should be used after boiling.

Water should be stored in a clean
covered container and a cup or a
laddle should be used for taking out
water.

Water supply in the village should
be protected by:
– Keeping wells covered
– Installing hand pumps.
– Building latrines at least 15
meters away and below the level
of any water source.
– Disposing of faeces and
wastewater away from any
source of water.
– Keeping buckets, ropes and jars
used for collection and storage
of water clean.
– Keeping animals away from
sources of drinking water.
– Avoiding use of pesticides or
chemicals near any water source.
181
Environmental Sanitation

Home and surroundings should be kept
clean.

Garbage should be collected in a
closed container and buried every
day.

All faeces – both human and animal
should be disposed of safely.

Construction and use of sanitary
latrines should be encouraged. It
should be constructed away from
source of water.

If it is not possible to use sanitary
latrines, people should defecate far
from houses, drinking water and place
where children play. The faeces
should be buried immediately or
covered with mud if defecated in open
areas.

Wastewater should be drained away
to soakage pits in the absence of
drains.

Cattle should be kept away from the
place where people live.

The use of smokeless chulhas should
be encouraged.
182
Information, Education
and Communication

183
184
 4 PART
Information, Education and
Communication

Page

4.1 Information, Education & Communication in ICDS 186

4.2 Communication: Definition, Concept and Process 187

4.3 Communication Functions and Barriers 188

4.4 Communication Channels, Media and Techniques 189

4.5 Social Messages and Communication Material 192

4.6 Planning & Organizing a Communication Programme 195

4.7 Communication Skills of an AWW 196

185
4.1 Information, Education & Communication
(IEC) in ICDS Programme
IEC Guidelines 2000

IEC in ICDS programme is in the form of Instructions and Guidelines issued by the
Department of Women & Child Development, Government of India.

As per Guidelines issued in 2000, IEC and Community Mobilization aims at sustainable
behaviour and attitudinal change of the society for holistic development of the child.

The major objectives of IEC Guidelines are to create awareness and build up image of
ICDS programme; stimulate demand for ICDS services; affect and sustain behavioural
and attitudinal changes in child rearing, nutrition and health care practices; and elicit
sustained community participation.

As per IEC Guidelines, principles of social marketing may be followed to formulate need-
based, area-specific and target-oriented IEC strategy.

Some of the IEC activities suggested in the Guidelines are home visits, small group
meetings, village level camps, project and district level seminars/meetings, nutrition and
health education sessions with mothers groups, use of slides, flash cards, flip charts, and
use of folk media and electronic media etc.

The State Governments/UT Admn. are to formulate suitable IEC strategy and
Implementation Plan as per the instructions given by the Department of Women & Child
Development, Government of India.

Information means telling

something to an individual about
a person or a thing or a subject.

Education is a gradual process of

learning through which a person
gains knowledge and
understanding of a subject.

Communication is a two way

process of giving information or
sharing ideas between two or more
than two persons.

186
4.2 Communication : Definition, Concept and
Process

Communication is a two way process

Elements of Communication
of sharing and transmitting ideas,
information and messages between two 1. Communicator
or more individuals. 2. Message
3. Medium
4. Receiver
5. Impact

Communication is an interactive
process of 5 elements which ensures:

Who?

Says What?

In What Channel?

To whom?

With what effect?

Communication Process
Communicator

Impact &
Message
Reinforcement

Receiver

Channel

187
4.3 Communication Functions & Barriers
Functions of Communication

Sharing of Information and Ideas

Increasing Knowledge

Influencing People for Change in Attitudes and Beliefs

Bringing about Behavioural Change

Persuasion & Negotiation

Motivation

Counseling

Giving Instructions

Reaching a Decision

Building Human Relationship

Entertainment

Communication Barrier
Communication becomes ineffective due to many hurdles called
‘Barriers of Communication’. A good communicator should
be aware of the following Communication Barriers and should
try to overcome them to avoid problems
 Poor planning
 Inadequate knowledge
 Too much or too less information
 Unaware of knowledge, attitude and practices of
community
 Failure to understand cultural differences
 Poor communication skills of communicator
 Poor presentation
 Selection of inappropriate channels & medium
 Selection of messages contradicting existing beliefs and
practices.
 Inadequate communication material
 Inappropriate language
 Various forms of external noise
 Insufficient feedback
 Technical errors

188
4.4 Communication Channels, Media and
Techniques

A variety of Channels, Media and Techniques can be used for communicating messages
at the community level.

Communication Channels, Media And Techniques

Mass Group Interpersonal

Communication Communication Communication

Electronic Media
Films; Film Quickies; Video Lecture; Group Meetings;
Home visits
Tapes; Video Quickies; Radio Demonstration; Camps; Field
Counselling
Programmes; Radio Spots; Visit; Role Play
Negotiation

Motivation & Persuasion
Audio Tapes; TV Programme;
TV Quickies / Spot, Slides etc.
Print Media
Books; Booklets; Folders and Flip Book, Flannel Graph,
Leaflets; Handbills; Letters; Flash Cards, Charts, Bulletin
Board
Newspapers, Advertisements,
Press release; Posters, Kiosks;
Photographs; Hoardings;
Magazines; Newsletters;
Journals.
Folk & Traditional Media
Song; Dance; Drama; Kirtan/
Bhajan; Puppet Show;
Nagada, Wall Writing etc.
Alternate Media
Street Play; Nukkad Natak,
Nautanki; etc.
Multi-media Campaigns
Publicity Campaigns /
Awareness Campaigns;
Exhibitions

189
Channels of Communication
Channel is a means of carrying information or a message from the
communicator to the target audience

Channels of communication can be classified as:

Mass Communication Channel
Means of communicating messages to a large group of people or masses.

Group Communication Channel
Means of communicating messages to a small group of people simultaneously and not
to an individual

Interpersonal
Communication Channel
Means of communicating messages to an individual face to face.

Points to remember while selecting a Channel

Availability

Purpose and suitability

Type of audience

Type of messages

Preference of audience

Communication skills of communicator

Cost effectiveness

Each Communication channel has its

own advantages and disadvantages.

Mass Communication is mainly used

for creating awareness and transferring
knowledge.

Group Communication is used for

reaching out to selected or smaller group
of people for motivating and influencing
them.

Interpersonal Communication helps in

changing attitudes and practices, and
bringing about behavioural change. It
enhances effectiveness of mass & group
communication, provides personal
reinforcement, is resource effective, and
is well accepted in rural and tribal areas.
190
Media
Media is an agency through which communication takes place

Media of communication are –

 Electronic Media  Print Media
 Folk and Traditional Media  Alternate Media (Nukkad Natak,
Street Play, etc.)

Points to remember while selecting a Media

Educational level of target audience.

Media habits of target audience.

Electronic media can have a better reach among a particular section of society and
can be used for creating awareness and reinforcement of messages.

Print Media has limited use in areas with low literacy levels.

Folk and traditional media is more popular in rural and tribal areas.

Media-mix approach or use of various media forms at the same time is more effective.

191
4.5 Social Messages and Communication
Material
Message is what is transmitted in the communication process and
message content is related to the behaviour that needs to be changed
or encouraged

Social Messages

Messages related to social issues are called social messages.

Messages should be transmitted in the local language, in appropriate tone and at the
appropriate time.

Messages should always be pre tested.

Characteristics of an Effective Message

 Message should be useful and comprehensive
 Message should be precise and clear.
 Message should be correct and complete.
 Message should be relevant and interesting.
 Message should motivate and lead to behaviour change.
 Message should reach the person through all five senses.
 Message should be as per the existing social norms and should not contradict prevalent
beliefs and practices.
 Message should be as per the felt needs of the community.
 Message should be to improve the knowledge and skills of audience.
 Message should be specific and scientific
 Message should be seeking attention, persuasive and convincing.
 Different messages are required for different target groups.
 Too many messages should not be given at the same time.

192
 Essential Facts for Life Messages

Health of both women and children can be significantly improved when births are
spaced at least two years apart, when pregnancy is avoided before age 18 and after
age 35, and when a women has no more than four pregnancies in total.

All pregnant women should visit a health worker for prenatal care, and all births should
be assisted by a skilled birth attendant.

All pregnant women and their families need to know the warning signs and problems
during pregnancy, and have plans for obtaining immediate skilled help if problems
arise.

Children learn from the moment of birth. They grow and learn fastest when they receive
attention, affection and stimulation, in addition to good nutrition and proper health
care.

Encouraging children to observe and to express themselves, to play and explore, helps
them learn and develop socially, physically and intellectually.

Breast milk alone is the only food and drink an infant needs for the first six months.
After six months, infants need other foods in addition to breast milk.

Poor nutrition during the mother’s pregnancy or during the child’s first two years can
slow a child’s mental and physical development for life.

All children should be weighed every month. If young child does not gain weight over
a two-month period, something is wrong.

Immunise children during the first year of life to protect against diseases that can cause
poor growth, disability or death.

Every woman of childbearing age needs to be protected against tetanus.

A child with diarrhoea needs to drink plenty of right liquids – breast milk, fruit juice or
oral rehydration salts (ORS). If the stooks contain blood or are frequent and watery, the
child is in danger and should be taken to a health centre for immediate treatment.

Most children with coughs or colds will get better on their own. But if a child with a
cough is breathing rapidly or with difficulty, the child is in danger and needs to be
taken to a health centre for immediate treatment.

Many illnesses can be prevented by good hygiene practices – using clean toilet or
latrines, washing hands with soap and water or ash and water after defecating and
before handling food, using water from safe source, and keeping food and water clean
and covered.
Source: Facts for Life, UNICEF, 2002.

193
Communication Material

Use of Communication material / Aids help in better understanding of messages being

communicated.

Communication material should be of good quality and should be pre tested before its
use.

While preparing or procuring communication material remember that communication
material should be:
Communication Materials

Attractive and appealing

Leaflets / Booklets / Pamphlets

Clear and precise

Posters

Pretested with correct messages
Charts

Durable
Flipbooks

Easy to use
Flannel Graph

Easy to carry and store
Flash Cards

Flip Charts

Cost effective

Slides

Film

Radio and Drama Scripts

Audio Tapes

Puppets

Folk Songs

194
4.6 Planning & Organizing a Communication
Programme
Communication programme should always be planned and based
on the needs of the target audience

Steps involved in organizing a communication programme are :

1. Identify ‘Communication Needs’ of the community i.e. the particular behaviour or habit
which has to be changed with the support of media.
2. Prioritise community needs and decide subject / topic for communication.
3. Identify target audience and assess their knowledge, attitude and practices.
4. Define communication goal & objectives.
5. Give a name to a communication programme with specific logo.
6. Prepare ‘Media Implementation Plan’ for each day as per the format.

Format for Media Implementation Plan

Name of When Where Commu- Target Channel Message Commu- Feed
Activity nicator audience & nication back
Medium Materials/
Aids
1 2 3 4 5 6 7 8 9

7. Identify suitable channels, media and techniques for communication

8. Develop suitable social messages and materials / aids
9. Procure or prepare communication material
10. Train communicators
11. Prepare budget and ensure its availability
12. Decide duration, place and time for organising communication activities.
13. Implement the programme, assess the impact and reinforce the messages, if required.
195
4.7 Communication Skills of an AWW

An AWW / field functionaries while communicating with mothers and community
members should remember 5 Essentials. They should always –
1. Ask
2. Listen
3. Praise
4. Advise
5. Confirm

Communication skills of an effective communicator are:

 Adequate knowledge
 Command on the local language
 Understanding of target audience
 Creating participatory environment
 Encouraging target audience to talk
 Patience and capacity to listen
 Speaking audibly in clear words with modulation in tone
 Effective body language
 Respect views of the audience
 Skill of handling communication aids and equipment
 Highlights salient points to sum up

196
Community Mobilization
and Participation

197
198
 5 PART
Community Mobilization and
Participation

Page
5.1 Community Participation, Mobilization and 200
Organization: Concept, Methodology
and Techniques

5.2 How to Conduct a Survey in a Community ? 205

199
5.1 Community Participation, Mobilization and
Organization : Concept, Methodology and
Techniques

An AWW is to educate, mobilize and organize the community so that

they can participate in ICDS programme actively for the cause of child
survival and development.

ICDS is basically a community

based programme and its
success depends on active
community participation.

In ICDS, community
participation is voluntary and
democratic involvement of
elders, local and religious
leaders, institutions and
organizations. It includes
community action and
decision - making in planning,
implementation and
monitoring of the programme
which leads to self reliance,
ownership and sustainability
of the programme.

Community refers to a village or a group of villages with families inhabiting them,

who are dependent on one another in their day to day transactions of mutual
advantages.
Community Participation is active involvement of people in planning, implementing
and monitoring of ICDS programme which is for their well-being. Community
participation is not just utilization of services and being passive users.
Community Mobilization is the process of bringing together or empowering members
of the community from various sectors to raise awareness on and demand for a
particular development programme. It facilitates change and development taking into
account the felt needs of the community and leads to community organization.
Community Organization is the process of organizing the community in such a
way that they can identify and prioritize their needs and objectives, develop confidence
and will to achieve them by finding resources through cooperative and collaborative
attitude, practices and community participation.

200
Why Community Participation in ICDS Programme?

Smooth functioning of ICDS

programme

Reach and increase in
utilization of ICDS services

Accountability for success or
failure of the programme

Reduce Government
intervention

Ownership of the programme

Sustainability of ICDS
programme

How can Community Participate in ICDS Programme?

Providing building for AWC

Bringing children to AWC

Contributing food and fuel

Providing old toys, materials to AWC

Supporting ICDS Programme through cash and kind

Arranging for safe drinking water

Preparation and distribution of supplementary food

Motivating parents to send children to AWC

Helping AWW in identification of beneficiaries and delivery of services

Organising meeting of AWW with local village leaders, Sarpanch and other influential persons

Telling stories and songs and
organizing group games for
children

Helping AWW in delivery of
health, nutrition and
education services

Creating demand for ICDS
programme

Acting as a pressure group
in smooth functioning of
Anganwadi Centre

Planning and implementing
the programme

201
 Role of Community in ICDS Programme

Community members have an important role to play in ICDS

programme

Community Member Major Role in ICDS

i) Gram Panchayat Provide building, promote delivery of

services and advocacy for ICDS

ii) Adolescent Girls Assist AWW in delivery of services

and help in maintaining cleanliness at
AWC

iii) Mahila Mandal Pradhan Encourage women to utilize ICDS services

and participate in activities at AWC

iv) Primary School Teacher Encourage community for sending their

children to AWC

v) Traditional Birth Attendant Link between community and AWW and

informing AWW of birth of children in the
village.

vi) Religious and Local Leaders Mobilise and organise community to

participate in ICDS programme

vii) Non - Governmental Organizations Support services to run the programme

effectively

vii) Village Women Utilize ICDS services and influence other

women for the same

202
 Eliciting Community Participation

How to Elicit Community Participation?

1. Assess Community’s needs
2. Build up rapport
3. Educate / mobilize / organize community
4. Involve Community in planning, implementation and monitoring the programme

Who can be Involved in Eliciting Community Participation?

Following members from the community may help in eliciting Community Participation:
– Panchayati Raj Members
– Sarpanch
– Religious & Local Leaders
– Mahila Mandal
– Youth Club Members
– Self Help Groups

Techniques of Eliciting Community Participation

1. Mother’s meeting and Community meeting
2. Advocacy campaign
3. Street play, skit or drama
4. Use of folk media and folk songs
5. Balmela / exhibition / sports meet
6. Use of PLA techniques

Indicators of Community Participation

– Community brings and collects children from AWC
– Contributes materials for PSE activities
– Helps in cooking and serving food at AWC
– Supports in maintaining AWC
– Provides food during gap period / shortage
– Provides place for AWC and storage facilities
– Visits AWC and help in solving the problem of AWW

203
 Points to Remember for Active Community Participation

Know your community well & understand community’s problems and their needs

Be aware of existing beliefs and practices prevalent in the community

Always listen to community members carefully

Do not introduce new interventions that are contradictory to existing practices and beliefs.

Try to analyse community dynamics and adjust in that situation

Involve community in ICDS programme right from the beginning

Give respect/importance to negative experience of the community, if any, and try to

minimize the negative feeling not only by sharing but also by doing

204
5.2 How to Conduct a Survey in a Community

Survey is a technique used for collecting information about the community and its
members.

An AWW should conduct a Survey in the village before starting the Anganwadi Centre
so as to know her community and beneficiaries.

During the Survey, information should be collected on a prescribed ‘Proforma’. It is to
be updated every month (Enclosed)

The information collected during the Survey includes:
– Total Population of the village
– Population of ICDS beneficiaries
– Number of ICDS beneficiaries as per services received
– Nutritional grade of children
– Children attending PSE
– Births and deaths during the month
– Any other information

Points to Remember

Visit each household along with the Helper for conducting Survey as per the prescribed
proforma

Establish good rapport with the family members & listen to their views and problems.

Additional information collected during the Survey should be recorded separately.

Remember to take proformas and weighing scale while conducting survey

Prepare ‘Family Summary’ at the end of each month (Enclosed)

Update the information collected during the Survey regularly as it is used to prepare
Monthly Progress Report and filling up various records & registers

205
 Proforma for Survey in a Village
INDIVIDUAL FAMILY RECORD
Line 1 : Serial No. of Family Line 4 : Date of Initial Survey
Line 2 : House No. Line 5 : Dates of Quarterly updates
Line 3 : - Marginal Farmer - IRD Target Family ________________________
- Landless Farmer ________________________
- Schedule Castes/Schedule Tribes - Monthly income of the
Family does not
Exceed Rs. 500

S. No. Name of the family Relationship Sex Date of Age Pregnant or Education Nut. S.N. Eligible At Risk Vital Events Handicaps
members to head birth Lactating or child Grade Yes/No Yes/No. /Death with
dates
206

1 2 3 4 5 6 7 8 9 10 11 12 13

FAMILY SUMMARY
Month Total Total no. of Total no. of Total no. of Children 0-6 Total No. of at No. of at Live birth Still Birth Total
No. of Eligible for S.N. Deaths
Reported Population Pregnant Lactating Years 8+9+10+11 risk mothers risk children 17++18+19
upto women mothers Below 6 6 month to 3 yrs. to 6 Pregnant Lactating Children Children 0-1 yrs. 1-3 yrs. 3-6 yrs.
month 3 yrs. yrs. Woman Mother 6 Months 3-6 years
–3 Years

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
 Management of
an Anganwadi Centre

207
208
 6 PART
Management of an Anganwadi Centre
Page

6.1 Leadership and Managerial Skills of AWWs 210

6.2 Maintenance of Records & Registers at AWC Centre 212

6.3 Monthly Progress Report 215

6.4 Self Appraisal and Self Development of AWWs 216

209
6.1 Leadership and Managerial Skills of AWWs

An AWW being a community worker has to mobilise community members and work as
a team with them to manage the service delivery at AWC. It is essential for her to possess
qualities and skills of a good leader and a manager.

An AWW with qualities of a good leader can transform the attitudes, beliefs, motives
and confidence of the community members to a large extent and her managerial
skills can help her to achieve the goals in stipulated time.

An AWW requires leadership and managerial skills for:

Decision making

Conflict management

Team building

Coordination

Effective communication

210
 Qualities of a Leader & a Manager

Charisma - Ability to influence and inspire people

Knowledge – Adequate knowledge of her environment in community and ICDS
programme, and her role and job responsibilities.

Self Confidence and Will Power – Confidence to meet the challenges and
expectations of the community.

Sense of Responsibility – Responsibilities to accomplish the tasks/goals of the
programme.

Enthusiasm – Energetic display of enthusiasm and interest to sustain better quality of
services.

Intellectual Stimulation – Identify, understand and solve problems

Communicative – Able to communicate with members of community effectively.

Empathy – Ability to look at things from others point of view.

Human Relations – Able to understand, adjust and work with people in a cooperative
manner.

Individual Attention – Personal attention to each child/mother/community member;
treating each person according to his/her needs, skills and abilities; and also advise,
guide and support them.

Willingness – Willing to take action when time is short

Motivating – Encourage others specially when tasks are difficult, prolonged, and
distasteful.

Involvement – Involve community members by sharing rewards and meeting their needs.

Integrity – Sacrifice self interests to accomplish what is best for the community.

Self Learning – Eager to learn new skills & techniques

An AWW may develop above qualities so that she can be an effective leader and a
manager

211
6.2 Maintenance of Records & Registers at
Anganwadi Centre

An AWW is to maintain records and registers for the services provided at AWC as per
the Guidelines and Instructions of State Govt. /U.T. Admn.

At Anganwadi Centre, Records and Registers help to:
i Assess reach and utilization of services
ii Identify services that need improvement
iii Access to data related to nutrition & health indicators of women and children
iv Facilitate supervision and training
v Assess self-performance

Make available information and data for monitoring and evaluation

Register 1: Anganwadi Survey Register

The Register has two parts -
1. Individual Family Record
2. Monthly Summary Record of All Families

Individual Family Record includes data of all the families and their members living in
the area covered by an anganwadi. AWW should complete the record during the baseline
survey and update it from time to time.

Monthly Summary Record of All Families has information of all families in the area
consolidated at the end of every month. Before filling up Monthly Summary Record of all
Families, AWW should review and update the ‘Individual Family Record’
Register 2 : Register of Services for Pregnant Women and Lactating Mothers

This register is for keeping record of services given to pregnant women and lactating
mothers. In the Register, information about pregnant women is given first and then about
lactating mothers.

In the register, record of supplementary nutrition provided, Iron & Folic acid tablets
given, TT Immunization, Health check-up, and Date of delivery of pregnant women is
recorded.

Every month the record should be updated and maintained on a new page.

Points to Remember for filling up Register 2

When a pregnant woman delivers “live birth” baby, delete her name from the list of
‘pregnant women’ and add it to the list of ‘lactating women’

If the baby is “still born” her name should not be entered for Supplementary Nutrition
given to lactating mothers.

When a lactating mother’s breastfed baby is six months old, delete the mother’s name
from the list and make sure the baby’s name has been added to the Individual Family
Record and the Register of Services for Children.

212
Register 3 : Register of Services
for Children

In this Register, record of $KTVJ
Supplementary Nutrition and &GCVJ
Preschool Education services 4GIKUVGT
provided to children is maintained.
Register 4 : Register of
#9
Immunization, Iron & Folic Acid 5WTXG%[
4G
IKUVG /CJKNC
and Vitamin A Supplementation 5VQEM T
/CPFCN
4GIKUVGT

This register is used for recording the 4GIKUVGT
immunization details of children
under six years of age, Vitamin A
drops, and also to record distribution
of Iron and Folic acid tablets given 5GTXKEGU
to children. Information on Annual HQT
Summaries of distribution of the %JKNFTGP
services is also maintained in this
register.
Register 5 : Birth & Death Register

This register is used for keeping record of total births and deaths in the area for children
upto 6 years of age.
Register 6 : Anganwadi Food Stock Register

Food Stock Register is a monthly food inventory report in which entries are made on all
the feeding days when AWW takes out the day’s ration for cooking or whenever she
receives stock.
Register 7 : Medicine Distribution Register

This register keeps the record of distribution of medicines by AWW to the beneficiaries.
Register 8 : Other Stock Register

The Register is to be maintained for any equipment or material supplied by the State
Government and the frequency of replenishment/replacement.
Register 9 : Mahila Mandal Register

Plain/Printed Register is used for recording number of meetings organized and number of
mothers attending the meeting. Information about area in which nutrition and health
education is imparted by AWW is also recorded.
Register 10 : Miscellaneous Register

Registers are also to be maintained for other services like Pradhan Mantri Gramodaya
Yojana (PMGY)/ Kishori Shakti Yojana (KSY)/ Balika Samriddhi Yojana (BSY)/ Self Help
Group (SHG) etc. AWW should maintain separate register for each programme to keep
record of services provided.

213
Register 11 : Supervision-cum -Visitor
-Visitor’ss Book

The Register is maintained at AWC for keeping record of comments and suggestions
given by CDPOs / ACDPOs / Supervisor / LHV / ANM or visitors during their visit to
AWC.

Register 12 : Daily Diary

An AWW is to maintain daily diary to keep record of all the activities conducted & the
work done by her during the day.

Pre-printed format/plain note book is used for this register.

Register 13 : Growth Chart Register

This is used for Growth Monitoring.

Register 14 : Mother & Child Card

This card is filled up by AWW/ANM to keep record related to health & well being of
mother and child.

Points to Remember

Register should be filled up and updated daily after delivery of services, filling up all
the columns.
 Information on some of the indicators like births, deaths etc. is to be updated every
month.

Individual Family Record should be filled up carefully, as accuracy of information of
many of the other forms depend on this information.

Records should be completed carefully as filling-up of Monthly Progress Report depends
on the accuracy of the registers maintained at AWC.

Pages of all the registers should be numbered.

Unnecessary scratching/cutting/overwriting should be avoided.

All registers should be covered properly and should be kept in a safe place.

Seek guidance from concerned supervisor for any confusion in filling up any column.

214
6.3 Monthly Progress Report

Monthly Progress Report (MPR) is an important tool used for monitoring the performance
and progress of an AWC.

Every month, an AWW has to report the progress of the work done at AWC on a prescribed
format and send it to CDPO office by the 5th day of every month through the Supervisor.

MPR is prepared on the basis of records and registers maintained at AWC.

Every month, during the circle meeting, Supervisors discuss the MPRs with AWWs and
do the same during the monthly meeting by CDPO.

CDPO consolidates the information of all AWCs under the Project for further sending it
to DPO, State Govt. and DWCD, GOI. The Progress Report is sent monthly, quarterly/
half yearly and annually.

MPR Data is useful for taking timely corrective action; know the shortcomings and
problems in the implementation of the programme; improve the delivery of various
services; and know the performance gaps between the targets and the achievements.

Points to Remember
AWW should fill up MPR carefully keeping the following points in mind:

Complete and update all records and registers at AWC regularly so that MPR can be
filled-up quickly.

Select relevant and specific information from the register for MPR.

Ensure that duly filled in MPR has correct data.

Always check the previous month’s MPR while filling up the current MPR.

Submit MPR to the concerned Supervisor on time and seek her guidance.

Retain a copy of the MPR for follow up action.

215
6.4 Self Appraisal and Self Development of
AWWs

Self Appraisal/Assessment is a technique to assess one’s own performance of work and
enable us to:

Appraise performance

Improve work performance

Set goals and make action plan

Solve problems

Establish check points for timely
completion of a task

Build confidence

Self development

Self Appraisal can be done by listing
one’s Strengths, Weakness /
Limitations, Opportunities and
Threats / Constraints.

Self Development is important for
quality performance. For this one should:

Regularly update one’s knowledge and skills

Attend training programmes from time to time

Develop a positive and healthy attitude of one’s own capabilities, skills and limitations

Share experience with other grassroots level functionaries

Regularly interact with community for quality improvement

Experiment innovative, need-based activities in the community.

Points to Remember

Build upon your strengths to improve capabilities

Be aware of your weaknesses and make efforts to strengthen them in such a way
that they become your strength.

Be aware of the opportunities available and improve your quality of work.

Be aware of threats so as to be cautious of the forthcoming problems and constraints
and to find ways to overcome them at the right time.

An AWW should do Self Appraisal regularly and look for

opportunities for Self Development

216
 Suggested Checklist for AWWs for Self Appraisal & Development
(For Self Appraisal
Appropriate Columns under Grades)

S. Indicators Grades
No.
Very Good Poor Very
Good Poor

1. Awareness of Role & Job

Responsibilities
2. Knowledge about ICDS Programme
and Services
3. Skills for Delivery of Services
3.1 Supplementary Nutrition
3.2 Growth Monitoring
3.3 Health Care
3.4 Preschool Education
3.5 Nutrition & Health Education
3.6 Referral Services
3.7 Identification of Children
with Disabilities
3.8 Eliciting Community Participation
4. Reach and Utilization of Services of
ICDS
5. Work Facilities & Environment
5.1 Location of AWC
5.2 Building of AWC
5.3 Set up of AWC
5.4 PSE Material
5.5 Supplementary Food
5.6 Medicines
5.7 IEC Material
5.8 Equipment
5.9 Records & Registers
6. Attitude towards Work
6.1 Willingness to work or perform duties
6.2 Willingness to accept responsibility
6.3 Desire to achieve goals & targets
6.4 Accept criticism in a mature and
healthy manner

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S. Indicators Grades
No.
Very Good Poor Very
Good Poor
7. Personal and Professional Qualities
7.1 Communicate effectively with Helpers,
Supervisors and CDPOs
7.2 Communicate effectively with other
health functionaries
7.3 Display patience and self control
during work
7.4 Demonstrate consideration for
other’s viewpoints
8. Leadership and Performance Qualities
8.1 Plan and organize work in a systematic
manner
8.2 Promptly carry out assigned tasks
8.3 Take initiative when necessary
8.4 Complete tasks on time
8.5 Observe rules and instructions
9. Relationship
9.1 Communicate effectively with community
leaders
9.2 Communicate effectively with mothers
and other community members
9.3 Aware of community needs & problems
9.4 Ability to Solve Problems
10. Opportunities for Self Development

Points to Remember

1. Remember this checklist is just to improve your work performance

2. Be honest in filling up the Form
3. You do not have to share your Self Appraisal with Supervisor or CDPO
4. After the Self Appraisal, note the areas for improvement. These will be under poor
or very poor and discuss the problems with your Supervisor
5. Be cautious of the problems in these areas and take necessary and timely action to
resolve them
6. Build upon the areas under ‘Good’ or ‘Very Good’ to improve yourself
7. Make efforts or look for opportunities for Self Development

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